Introduction to the Project
The project will primarily focus on the issue of opioid abuse and addiction to treat and minimize the effects of pain through the given pharmacological method of pain management. The project’s accentuation is centered around the utilization and implementation of physical therapy or PT, which is a form and subset of a wide range of alternative pain management strategies and frameworks. Opioid overuse can be categorized as one of the major challenges of the United States’ healthcare system since the drugs are highly effective at reducing the severity of both acute and chronic pain. However, these measures come with a substantial drawback, where users of opioids become addicted to them, which perpetuates a continuous cycle of use of these pharmacological methods as the only means for pain management (Centers for Disease Control and Prevention [CDC], 2017). Therefore, with such a wide-scale use of opioids, the drugs are often misused, where they are not used for their intended objectives, which mainly involve surgical interventions and specific illnesses (Neuman et al., 2019). Therefore, the major dilemma is put before medical experts, especially physicians, who need to decide whether or not to let a patient suffer from pain or prescribe a highly addictive drug with long-term health ramifications (Volkow & McLellan, 2016).
The project proposes that alternative pain management strategies will be as effective as opioids and can become a complementary or even replacement treatment for both acute and chronic pain. The main reason is that the effectiveness of alternative pain management methods is rooted in the fact that they can be of equivalent strength compared to opioids with no negative complications, such as addiction, overuse, and misuse (Agency for Healthcare Research and Quality, 2020). The given chapter will mainly cover the background of the project, problem statement, purpose of the project, clinical questions, significance of the project, rationale for the methodology, project design, term definitions, assumptions and limitations, and summary.
Background of the Project
It is important to note that the overuse of opioids as a form of treatment for pain management is a major epidemic in the United States. The current data suggest that unintentional opioid overdoses, which result in deaths, increased fivefold between 1999 and 2016 in the state of Connecticut (Clinton et al., 2019). In other words, the historical background of the problem of interest indicates that the severity of the opioid epidemic is rising.
The current state of the problem is at its worst in terms of healthcare outcomes alongside costs and economic burdens. According to CDC (2018), There are also substantial economic impacts in regards to opioid overuse, which is estimated to be $78.5 billion annually, and it is reflected in a loss of productivity in a region as well as direct healthcare costs. In other words, despite a series of large-scale efforts to combat the epidemic, no significant improvements have been made, which is indicated by the alarmingly high rates of mortalities directly tied to opioid overdoses.
Subsequently, the cause of the issue is opioids themselves, which can be categorized as powerful drugs with serious side effects and complications. Therefore, the project’s focus will be put on minimizing or even eliminating the use of opioids as means of pain management and replacing them with alternative pain management strategies, such as physical therapy.
The problem statement is rooted in the fact that there is no data or information on the effectiveness of alternative pain management strategies, particularly physical therapy. In other words, this knowledge gap creates a need for assessing and analyzing the effects of physical therapy in pain reduction for a patient with chronic or acute pain. While the current literature shows that physical therapies and alternative pain management strategies are effective, it was not known if or to what degree the implementation of physical therapy would impact pain management as well as level when compared to opioids among patients with acute and chronic pain at their end-of-life stages. Therefore, the project will reveal the effectiveness of physical therapy as a method of pain management, and it will also provide accurate metrics on the varying degrees of effectiveness.
The project will be primarily conducted among adult patients at their end-of-life stages. The selected population of interest is the most vulnerable individuals since pain management becomes a major aspect of their lives. There are adverse effects of opioid use for pain management, which is becoming a widespread issue, and thus, alternative measures, especially physical therapy, under a correct setting can be an effective replacement. Therefore, the project can contribute to solving the problem by determining whether or not physical therapy is as effective as opioids.
Purpose of the Project
The purpose of this quantitative project is to determine if or to what degree the implementation of physical therapy would impact pain levels when compared to opioid-based pain management measures among adult patients experiencing chronic or acute pain in a skilled nursing facility in California over 4-weeks. The project will contribute to the field of pain management by improving the overall understanding of physical therapy’s effectiveness as an alternative solution for chronic and acute pain. The participants of the project will come from the facilities for the management of chronic or acute pain.
It is important to note that pain level will be the core dependent variable metric, which will dictate whether or not physical therapy can be categorized as effective or ineffective as a pain reduction approach. The measurements will be conducted in two methods, where the first one will be based on the quantity of the medication consumed by a patient during the selected period. The second method will focus on measuring the intensity of pain on a numerical rating scale or NRS, which will be self-reported by the participants. The independent variable will be the use of physical therapy to manage chronic and acute pain among the patients, which means that it will be a categorical variable. The findings will be highly useful for healthcare professionals since they will be more knowledgeable on physical therapy’s effectiveness.
One of the objectives of care plans in regards to patients is effective pain management strategies. The most common approach is a prescription as well as provision of opioids, despite the overall availability of alternative solutions. At nursing care centers, similar patterns can be observed, which is why providing evidence on the effectiveness of physical therapy is critical. In other words, such facilities have access to physical therapy, but the use of the method is low, which could be due to the lack of evidence or knowledge on their effectiveness. Therefore, the project will facilitate the overall adoption and promotion of physical therapy as an alternative pain management strategy if the results indicate that physical therapy is as effective as opioids for both acute and chronic pain.
The following clinical question guide this quantitative project: To what degree does the implementation of physical therapy impact the pain levels when compared to opioid prescription and provision among adult patients with chronic and acute pain in a skilled nursing facility in California?
Advancing Scientific Knowledge
The gap or problem is rooted in the fact that there are adverse effects of opioid use for pain management, which is becoming a widespread issue, and thus, alternative measures, especially physical therapy, under a correct setting can be an effective replacement, but the latter statement requires proper research and assessment. Lewin’s change management theory, Nightingale’s Environmental theory of nursing, and Newman’s theory of health as expanding consciousness serve as foundational theoretical frameworks for the given project. On the one hand, Lewin’s change management theory is centered around the notion of human behavior being primarily impacted by change opposing or restraining forces and change promoting influences, and the dynamics between these two forces can be altered through effective intervention measures to make quality improvements (Wojciechowski, E., Pearsall, T., & Murphy, P. 2016).
On the other hand, Nightingale’s Environmental theory of nursing is mainly focused on the major impact of external elements and conditions surrounding a patient, where the emphasis is made on the general importance of preserving and improving the patient environment to enhance their recovery. In addition, Newman’s theory of health addresses the importance of health and sickness being interconnected with individuals near a patient, such as caregivers and nurses, and thus, healthy people providing care for a sick person enhances the recovery of people with illnesses. Therefore, the project will advance these theoretical foundations by conducting a practical analysis of physical therapy’s effectiveness at reducing pain levels, which will either show that it can be used in conjunction with opioids and even replace them or show that the method provides insignificant changes.
Significance of the Project
Replacing opioids with alternative pain management therapies can decrease or eliminate the negative consequences of opioid abuse and addiction. The pain began to acquire the status of not only a syndrome but also a separate nosology. Its formation depends more on a complex of psychological factors than on the nature and intensity of peripheral nociceptive influence. The main difference between chronic pain and acute pain is not the time factor but qualitatively different neurophysiological, psychophysiological, and clinical relationships.
A wide range of conventional pain management interventions and frameworks have no understanding of key intricacies of pain treatment, do not emphasize the measures based on solid evidence, and do not promote a proper education of medical professionals on pain treatments, which can be considered as significant contributors to the proliferation of opioid abuse (Manchikanti et al., 2020). Currently, priority is given to conservative methods of treatment, and it is necessary to take into account the intensity of the pain syndrome, the tendency to the chronicity of the process, the individual characteristics of the patient’s personality, concomitant pathology of internal organs, and use both medication and non-medication methods of treatment.
A systematic review on pain management revealed that the given subject is of the highest interest among researchers, and understanding the underlying mechanism behind pain is critical to developing and improving non-pharmacological methods of pain management, where the physical aspects of pain require particular attention (Chen et al., 2021). The general principles of pain treatment provide for a clinical assessment of the state of the neurophysiological and psychological components of the nociceptive and related systems and the impact on all levels of the organization of this system, should be aimed primarily at eliminating the source of pain and restoring damaged tissues, and acting on the peripheral components of pain should be based on the principles of integrative medicine and include the combined use of drugs, various methods of physiotherapy, reflexology, the use of manual therapy, massage and physiotherapy exercises.
Therefore, it is evident that the current literature supports the fact that alternative pain management measures are as effective as opioids if implemented correctly, but there is no data on the degree of effectiveness of these methods in comparison with opioid pain treatments. In addition, opioids are associated with addiction, massive healthcare and productivity costs, and deaths due to overdoses. Since physical therapy does not have these adverse effects, it is important to determine whether or not physical therapy can replace or at least reduce the prescription rate of opioids.
Rationale for Methodology
The project will primarily utilize a quantitative methodological approach with relevant procedures to evaluate the variations in pain levels associated with the control condition, which is an opioid treatment, and the experimental condition, which is physical therapy. The NRS metric will be employed to measure the degree of pain as well as the number of consumed medications to have another method for pain level analysis. It is important to note that the quantitative method is the most appropriate to the project since it enables objective comparison of the numerical data derived from the assessments (Rutberg & Bouikidis, 2018).
In addition, the investigator will work on collecting a sufficient amount of data to evaluate whether or not the alternative pain management therapy is effective at reducing pain (Creswell & Creswell, 2018). The selected methodological framework’s advantage is rooted in the fact that it illuminates not only the comparative effectiveness of each treatment but also gives an accurate representation of the overall degree of efficacy.
Nature of the Project Design
The investigator will utilize a quasi-experimental design to address the clinical question through an application of the intervention of interests, which is physical therapy. The efforts will be put into the identification of pain level alterations post-therapy. The project design allows the investigator to accurately evaluate the effectiveness of each therapeutic method since the structure of the experiments is not solely comparative but also inherently enabling of measuring the degrees of effectiveness.
Under a quasi-experimental framework, it is possible to influence the dependent variable through an independent one, which will provide a basis to observe the causal relationships between them. Unlike correlational design, the selected structure does not merely observe patterns between two variables but directly affects the variable of interest, which means the investigator can assign causality to the observed phenomenon (Yin, 2017).
Definition of Terms
The following terms were used operationally in this project.
Addiction is a malfunction or dysfunction of brain circuits in regard to memory, motivation, and reward systems (American Society of Addiction Medicine, 2021).
Appropriate Opioid Prescription
Appropriate opioid prescribing is a practice of properly managed pain control with measures of misuse and toxicity reduction of a substance (Preuss et al., 2018).
Clinical significance means that findings are meaningful and reproducible with long-term effects (Armijo-Olivo, 2018). The project is clinically significant since it can offer alternative solutions for opioid pain management approaches, such as physical therapy as a treatment with no misuse and addiction risks.
Statistical significance refers to the generalizability and importance of the project findings through hypothesis testing (Armijo-Olivo, 2018).
Comparison and Intervention Group
Intervention groups is an experimental group, which receives the intervention of interest, whereas the comparison group acts as a control group, which does not receive the intervention of interest (Ramos et al., 2017).
Assumptions, Limitations, Delimitations
It should be noted that the project is conducted under the assumption that healthcare conditions under which the observations and assessments are done are equivalent or reflective of the general setting among all other healthcare facilities. In other words, the results and outcomes of the project can be utilized to make relevant use of these findings among other healthcare facilities.
In the case of limitations and delimitations, the following are present in this project:
- The project’s sample size can be categorized as insufficient to make generalized and broad conclusions.
- In addition, the project is primarily conducted in a single healthcare facility, which might not be reflective of other healthcare units, which means that the findings can be skewed by the specificities of the selected setting and place.
- A potential delimitation for the project is rooted in the allocated period, which is four weeks long, and thus, to make the findings more conclusive and substantiated, it is possible to increase the overall sample size and extend the period of the project.
Summary and Organization of the Remainder of the Project
Opioid drugs are highly effective pain killers and relievers, but they can also cause epidemic level abuse when broadly prescribed. For instance, prescription-related and unintentional cases of opioid overdoses increase fivefold from 1999 to 2016 in the state of Connecticut (Clinton et al., 2019). There are also major financial implications for a population having drug, especially opioid abuse issues since its effects are manifested in an economic burden in a region due to high rates of morbidity and mortality. The estimated annual cost of productivity losses as well as healthcare expenses associated with opioid abuse is around $78.5 billion (CDC, 2018). Since the prime use for opioid drugs, which causes unintentional abuse, is pain relief, there are effective alternative options, including both pharmacological and non-pharmacological ones (Agency for Healthcare Research and Quality, 2020). Physical therapies are among the most effective pain management strategies, especially for musculoskeletal conditions, since these measures address not only the pain itself but also its source (George & Goode, 2020). The purpose of this quantitative project is to determine if or to what degree the implementation of physical therapy would impact pain levels when compared to opioid-based pain management measures among adult patients experiencing chronic or acute pain in a skilled nursing facility in California over 4-weeks.
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