Pain Management Model

Opioid addiction is so prevalent in the healthcare system because of the countless number of hospital patients being treated for chronic pain. While opioid analgesics have beneficial painkilling properties, they also yield detrimental dependence and addiction. There is a legitimate need for the health care system to provide powerful medications because prolonged pain limits activities of daily living, work productivity, quality of life, etc. (Taylor, 2015). Patients need to receive appropriate pain treatment, however, opioids need to be prescribed after careful consideration of the benefits and risks.

The middle range theories consist of two more concepts, and these concepts are concrete and operationally explained. The hypothesis from middle range theories is testable. These theories are specific to the problem (McEwen, &. Wills, 2014). The middle range theory of Acute Pain Management by Good and Moore established in1996 used in the management of acute and chronic pain.

While our major access to these drugs is doctors, we cannot simply lay blame on them, as there is not enough knowledge about these treatments to correctly appropriate drugs, and therefore extra is given (Hemphill 373). Alexander of the Department of Epidemiology of the Journal of the American Medical Association, states that “There are serious gaps in the knowledge base regarding opioid use for other chronic nonmalignant pain” (Alexander 1865-1866), which leads to the unfortunately large number of leftover drugs. In fact, the main place that people get their drugs are from leftover prescriptions (Hemphill 373).

What is pain? If you ask someone to tell you the definition of pain they will typically state something that hurts. Registered nurses should know the definition of pain and how it can be identified on their patients. However, Abdalrahim, Majali, Stomberg, and Bergbom (2010) propose that nurses did not receive adequate education in pain management and suggest the lack of knowledge hinders their ability to adequate control their patients’ pain. Therefore, the unethical treatment of pain can be traced back nurses.

Statistics for the growing prescription opioid abuse problem are alarming. Prescription analgesics are the second highest dispensed drug in the healthcare system. (Younger, et al., 2011). In 1991, approximately 76 million prescriptions were written for opioids. By 2011, that number had grown to 219 million (Jamison & Mao, 2015). Around 63 million people in the U.S. have used nonmedical prescription

Opioid abuse, misuse and overdose is a problem in The United States. You can’t turn on the TV or read a newspaper without some mention of the epidemic. This issue has caused the practice of prescribing or taking narcotic pain medication to be looked at under a microscope. Patients are fearful to use some necessary pain medication, because they may become addicted. Other patients who genuinely do have pain and need medication are having a tougher time obtaining the help they need. The problem of abuse and addiction is tough to solve since for some people the medications are the only way they can function and live a semi-normal life. A patient with pain may be hesitant to visit the doctor and

Considerable cautions have been obtained throughout the United States to decrease the misuse of prescription opioids and helps to minimize opioid overdoses and related complications. Even though the pain medications have a significant part in the treatment of acute and chronic pain situations, it sometimes happen that the high dose prescription or the prescribed medications, without having enough monitoring, can create bad outcomes. It is always a dilemma for the providers to find who is really in need of pain medications and to identify those who are questionably misusing opioids.

These efforts are focusing little attention on the source of the medications themselves, the access point -- the medical practitioner with a pen. In the current environment, a doctor, dentist, or nurse practitioner can write a prescription to anyone without accountability for the aftermath. In March the CDC convened to put forth guidelines for prescribing opioid medications in cases of chronic pain (Dowell, Haegerich, & Chou, 2016, pp. 1633-1641). The published guideline is a passive 12 point recommendation for prescribing practices without accountability, solutions, or intention to enforce better practice. To date, the national response to the crisis can be described as impotent at best, and the body count rises. “Drug overdose is the leading cause of accidental death in the U.S., with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.” (ASAM,

Jamison RN, Serraillier J, Michna E. Assessment and treatment of abuse risk in Opioid prescribing for chronic pain. Pain Res Cl. 2011;2011:1-12. doi:10.1155/2011/941808.

Mike Alstott knows first-hand how opioids, when used correctly, can play an important role in managing pain and helping people to function, but he is also keenly aware of the growing crisis of opioid misuse and overdose. More American adults are dying from misusing prescription narcotics than ever before. An estimated 35 people die every day in the U.S. from accidental prescription painkiller overdoses resulting from things like not taking a medication as directed or not understanding how multiple

Although addiction and overdose of opioids was not declared an epidemic by the Center for Disease Control and Prevention (CDC) until 2011, the beginning of the epidemic can be traced back as early as the 1980’s when attention in medical care began to turn toward pain management. By the early 2000’s the Joint Commission on Accreditation of Healthcare Organizations named pain “the fifth vital sign,” implying that pain is as important clinically as pulse rate, temperature, respiration rate, and blood pressure (Wilson, 2016). At the same time, there has been an emphasis change from patient wellness to patient satisfaction metrics. Non-steroidal anti-inflammatory drugs such as Advil, Aleve, or aspirin have raised safety their own safety concerns, contributing to increased use of opioids. The lack of patient access to and insurance coverage for chronic pain management specialists or alternative healing therapies also contributes to the opioid epidemic (Hawk,

Through my observations of the Narcotics Anonymous meeting I believe that my analysis could be beneficial to the realm of medicine. Centers for Disease Control and Prevention (2014) released a study that displayed, “health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills.” Considering the mass amount of prescriptions being written nationwide, it is not surprising that one of the members in the NA meeting I attended was able to easily obtain painkillers from her doctor. The specific interaction I encountered during the Narcotics Anonymous meeting where the woman described that her addiction was being supported by the constant prescriptions written by her doctor

The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in that it is also predominant in the middle and affluent classes. Ultimately, anyone can be fighting a battle with addiction and it is important for family members and loved ones to know the signs. The cause for this epidemic is that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians.

In fact, there was thought to be more of a need for them. Before the last two decades, opioids were used for cancer related or acute pain. However, in the 1990s chronic non cancer patients got attention because people nationally felt there was a shortage in patients receiving opioids, thus making them deprived of adequate pain management. Because of this, clinicians were encouraged to treat chronic non-cancer pain and patients in hospice care more often than they were used to. It was also encouraged to use high doses of opioids for long periods of time (Cheatle). The idea that providers seemed overly cautious about these medications caused a large increase in opioid prescriptions from health care providers. Threat of tort and litigation for some doctors that were deemed for not prescribing enough to alleviate pain of patients was also a concern for doctors This quickly turned a shortage of prescription opioids into a national prescription opioid abuse epidemic in under twenty years. From 1999 to 2010, the amount of prescription opioids sold to hospitals, pharmacies, and doctors offices quadrupled, and three times the number of people overdosed on painkillers in this time (Garcia). While some patients have benefitted from the increased sales and loose guidelines of prescription opioid analgesics, the increasing in opioid misuse, abuse, and overdose is truly daunting. As a nation, we need to back track, and

Culture plays a significant role in pain perceptions, behaviors, expressions, and attitudes toward pain medication (Ho, 2013). Pain behaviors vary widely and may be culturally bound. Some patients cope by turning inward, describing pain as a private and personal experience. As nurses we tend to assume that communicating about pain will seamlessly cross cultural boundaries. Thus, people of different culture respond to pain differently. In order to provide culturally sensitive pain management, the patient’s pain must be considered within the context of the individual’s beliefs and values as culture may influence the individual’s perception and response to pain, whether or not the patient will ask for pain medication, or whether the use of traditional healing practices take precedence over Western medical treatment (Dhingra, 2008; Im, et al., 2010; Mossey, 2011; Narayan, 2010; Shavers, et al., 2010). Healthcare professionals must be knowledgeable of culture difference to be able to deal with social and culture issues.