Treatment From Expert Opinions And Case Reports

The patients who are in pain requires pain relief, but many of them with chronic pain have trouble with prescribed opioids either due to psychosocial problems

Published studies of psychosocial factors or interventions associated to PDN were reviewed. This included a search of the following electronic databases, from 1946 to up to 10 August 2017: Medline, Embase, PsycInfo, Cinahl, Web of Science, ISRCTN registry, ClinicalTrials.gov registry, and EU Clinical Trials registry. Also, the reference lists of all included papers and of related published reviews (e.g., Eccleston et al., 2015) were screened to identify any additional eligible studies.

The selected policy Essence of Care 2010: Benchmarks for the Prevention and Management of Pain, includes the latest benchmarks on the management of pain and its prevention. It presents up to date reviewed views, with the aim to deliver

Chronic pain is an important public health problem that negatively impacts the quality of life of affected individuals and exacts a tremendous cost in both healthcare costs and lost productivity. The Institute of Medicine (IOM) in its landmark report on relieving pain in American estimated that 100 million individuals suffer from chronic pain at a socio-economic cost of between $560 and $635 billion annually [IOM, 2011]. Opioids have been increasingly prescribed for the management of chronic pain, and along with this increase in use has come an increase in opioid misuse and abuse. Of the opioids that are abused, 60% are obtained directly or indirectly through a physician’s prescription.

Recognizing that the prevention of chronic disease and promoting population health is the key to controlling health care expenditure, the inclusion of pain management is a positive aspect of the legislation. While chronic pain is not in the top leading chronic diseases, the cost to the health care system is higher than heart disease and diabetes combined.2 This paper will discuss Title IV - Prevention of Chronic Disease and Improving Public Health. Subsection D - Support for Prevention and Public Health Innovation of the PPACA, including the funding of the United States Department of Health and Humans Services (HHS) for research in public health services and the examination of best prevention practices. One focus of this part of this provision is research and evaluation of pain management, the assessment, and treatment standards through an Institute of Medicine Conference on Pain Care.3

The primary protocol for pain is prescribing opioid medication. In 2016, the CDC has established guidelines for prescribing opioids entitled, CDC Guidelines for Prescribing Opioids for Chronic Pain (Centers for Disease and Control, 2017 -a). The guidelines included nonpharmacologic and non-opioid pharmacologic therapy, when to prescribe or stop opioids, discussing pain goals as well as discussing the risks and benefits throughout care (Centers for Disease Control, 2017 -a). Upon the release of the CDC guidelines, the White House asked medical schools to include the guidelines into their medical curriculums

The research compiles a qualitative review of peer-reviewed journals with evidence reports and expert recommendations regarding adverse effects of long-term opioid use for noncancer related chronic pain treatment. Data was collected through article searches which located 43 articles with data for increased adverse effects of opioid use. The data was then integrated to identify the most significant perilous effect by organ system.

Pain medications result in complicated side effects beyond addiction and tolerance which is Opioid-Induced Hyperalgesia (OIH). “There’s an unfortunate irony for people who rely on morphine, oxycodone, and other opioid painkillers: The drug that’s supposed to offer you relief can actually make you more sensitive to pain over time” (“Why Taking Morphine Makes Pain Worse”, 2016). This effect of the drug is known as hyperalgesia but in the presence of opioids; this is known as Opioid-induced hyperalgesia. Opioid is a well know drug originated from the opium poppy plant and it has been around for thousands of years for both recreational and medicinal purposes. The most active purpose for this drug is to relieve pain which is also known as a painkiller. There is a law stating that all contents must be labeled on all medicines containing opioid; “Congresswoman Annie Kuster (NH-02) welcomed today’s announcement by the Food and Drug Administration (FDA) that it would begin requiring warnings for medications that contain opioids” (“FDA Policy to Require Labeling of Prescription Medications Containing Opioids”, 2016). This drug should not be taken without direct orders from a doctor nor should it be misused. Scientists have observed that the more an individual consumes, the less effective the drug becomes. This leads to a viscous cycle of people relying on higher doses. Opioid sets off a chain of signals in the spinal cord that heightens pain rather than reducing it, even after the

But for most conditions, there is little evidence that opioid-based treatment is more effective than other options (Pho 8). For back pain, migraines, and pain related to surgery, there are many alternative treatments such as physical therapy or anti-inflammatory drugs (“Safer Alternatives” 3). This is due to the fact that opioids are easier to prescribe or even because their patients demand them (“Safer Alternatives” 3). Unfortunately, it is also because insurance plans don’t always cover alternative treatments that may help the patient (“Safer Alternatives” 4). This can lead to patients getting addicted to opioids for something that could have been easily treated using an alternative treatment. In some cases, the doctors may be susceptible to bribes. For example, six executives from Insys

Despite the fact that pain is universally recognized as a part of the healing process, ways to minimize its impact on patients have not been aggressively pursued. The modern perspective of pain merits the use of painkillers for both short term and chronic pain, but studies suggest that the likelihood of drug dependence increases with the intensity of the pain, extent of drug use, and frequency of drug use. (Elander, Duarte, Maratos, & Gilbert, 2013). Patients may prefer not to use painkillers such as opioids due to debilitating side effects and fear of developing dependence, yet there are few alternative methods taught to patients to help manage pain.

On the other hand, I understand the matter of prn pain medication abuse. Again, the patient’s expression of pain is the sole indicator, so it is important to respond. Potash (2010) suggest a health history and exploring the patient’s past and identify if anything can be a trigger. Further, it’s important to try trial and error because the current medication, is not providing a therapeutic effect for the pain. As a result, figuring out a new balance, perhaps discontinuing a medication and prescribing one with a higher therapeutic window. Also, daily pain assessments to evaluate the effectiveness of the new pain. The primary focus is decreasing the pain.

Chronic pain is any pain that lasts longer than 3 months (FNLM, 2011). A common type of chronic pain is neuropathic pain which occurs when the nerves themselves are damaged by injury or disease (Veteran Mates, 2013). Neuropathic pain is a complex condition that is often underdiagnosed or undertreated, resulting in negative physical, psychological and social impacts (Veteran Mates, 2013). Therefore early management is critical in order to improve the person’s quality of life and to reduce the chance of the pain becoming persistent (Pain Health, 2015). The following 5 articles relating to the management of neuropathic pain will be annotated, including a summary of the main

Chronic, acute, somatic and oncologic are all types pain - each with their own symptoms, reliefs, and evaluations. As pain has been explored, we have learned more about it; however, it remains an anomaly. In the postoperative setting, nurses are the first line of pain management. Their assessments of the patient’s pain, including questions and scaling is imperative when dosing medications and evaluating the patient. Studies continue to determine that healthcare providers undertreat and mismanage pain control and assessment. According, to the American Society of Interventional Pain Physicians, “80% to 90% of physicians have had no formal training in prescribing controlled substances, and only five out of one hundred thirty-three medical schools in the U.S. have required courses on pain management” (Glowacki, p. 37). The American Nurse Credentialing Center reported that “as of 2013, only one thousand six hundred seventy two registered nurses in the U.S. were certified in pain management” (Glowacki, p. 37). According to the CDC, about 50% of postoperative patients report unrelieved pain (Centers for Disease Control and Prevention, 2013). Effective postoperative pain control is necessary for successful care and treatment. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing (Francis &

The results from this study demonstrated that forced-exercise and antiparkinsonian medication resulted in a similar level of improvement in PD symptoms. Both types of interventions also resulted in similar patterns of activation on the fMRI. This suggests that there is a mechanism of action within the brain that are common, that results in symptomatic relief. Both FE and medication have shown to produce significant improvement in PD symptoms. All the participants in the study reported experiencing symptomatic relief after the forced exercise. This study showed that forced-exercise may be a used as a noninvasive adjunct to medication for individuals with PD.

Subjects who had a low resting frequency of skin sympathetic nerve activity possibly had this due to lower than normal noradrenaline levels, however this was not explored in detail. **Shindo et. al** postulated that PD patients may develop denervation hypersensitivity of adrenergic receptors in the cutaneous blood vessels which presents an undeveloped field of study regarding the recognition of and potential alleviation of symptoms in PD. If the causes behind post denervation hypersensitivity (the hypothesised cause of prolonged vasoconstriction of cutaneous blood vessels - which has been experimentally **proven** to be the cause of cold-limbs and abnormal thermoregulation) were to be solved, work could begin on treatments which would successfully relieve the thermoregulatory symptoms of PD which are known to cause reasonable discomfort. Both studies are working towards understanding this process and have made a contribution to the current knowledge of the biological process affected by PD. As **research article** states, the treatment of thermoregulatory dysfunction in PD has not been thoroughly studied, however the sufferers who deal with the results of a dysfunctional thermoregulatory process on a daily basis would