3033336_Non-Opioid_Pain_Intervention_for_Veterans
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Non-Opioid Pain Intervention for Veterans
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Antioch University Santa Barbara
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Table of Contents
Abstract
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Objectives
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Methods
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3
Results
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Conclusion
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Background
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Problem
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Clinical Questions
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PICO Questions
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Population
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Intervention
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Comparison
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Outcome
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Specific Aims
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Methods
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Review of the Literature
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Overview
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Histopahthology of Opioid Addicition
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Opioid And Non-Opioid Use In Pain Management
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Non-Opioid Interventions
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Effectiveness Of Non-Pharmacological Interventions
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12
Summary and Conclusions
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References
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15
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Abstract
Objectives
Opioid addiction is increasingly affecting the strategies enacted to manage chronic pain among
veterans effectively. The use of alternative non-opioid interventions has been discussed in this
paper, with its effectiveness being more operative to veterans. In this case, non-opioid modalities
have an increased long-run benefit and are more effective in managing chronic pain among
veterans.
Methods
This paper follows a systematic review of 20 research articles from reputable sources to discuss
the effectiveness of non-opioid modalities in pain management among veterans and the risks
associated with opioid use for the same purpose.
Results
The use of non-opioid modalities for pain management has been associated with increased
effectiveness in pain management among veterans in the United States. Findings link its use to
reduced opioid addiction and enhanced pain management.
Conclusion
In the increased effectiveness of non-opioid modalities for pain management among veterans,
this paper concludes by indicating the risks of opioids for the same purpose. As a result of the
increased risks associated with opioids, non-opioid modalities have been recommended for
chronic pain management.
Keywords:
Opioids, non-opioids, veterans, chronic pain
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Non-Opioid Pain Intervention for Veterans
Background
The increasing reliance on opioids for pain medication has increased the overall drug
overdose in the United States. Currently, veterans endure chronic pain from the battle and
through musculoskeletal injuries. In this case, drug-related overdose among veterans in the
United States increased in the past 15 years due to opioid use (Hsu et al., 2019). Opioids may
effectively reduce the musculoskeletal pain that veterans may suffer as a result of injuries but
may cause an addiction. It may be understood that veterans' chronic pain may not be easily
managed permanently. Therefore, the easily-available opioid prescriptions may guide the
effectiveness of its interventions while causing an addiction problem. An increasing body of
evidence points towards the harms of opioid treatment and limited long-term benefits of its use,
leading to the emphasis on non-opioid interventions (Frank et al., 2019). Non-opioid
interventions are increasingly gaining popularity as a result of their long-term effectiveness in
chronic pain management. Non-opioid interventions may include various initiatives such as
specific physical exercises, non-opioid medications, and placebo. These initiatives have
presented a high chance of success in pain management among veterans to emphasize its use in
the current pain management techniques.
While opioids may negatively impact the patient's health in the long run, it is essential to
understand what causes an increased reliance on this intervention for veterans. Pain is the leading
source of increased reliance on opioids among all Americans (
Pain Management
, n.d.). In
essence, musculoskeletal pain accounts for most of the veteran's need for opioid pain
medications. From a hypothetical perspective, musculoskeletal pain from injuries may be
unbearable to the veterans, leading to interventions to reduce this outcome. There are various
6
causes of these injures among veterans, impacting their reliance on this modality for pain
management. Musculoskeletal injuries from the battlefield are a leading cause of pain among
veterans (Molloy et al., 2020). Military battlefields have intense operations which involve the use
of dangerous weapons. This may lead to uncertain outcomes such as skeletal injuries, which may
cause increased use of opioids for pain management. While this outcome may cause such
injuries, it is essential to consider high BMI as a catalytic factor. Research indicates that a high
BMI increases the risk of developing musculoskeletal pain (Higgins et al., 2020). In this case, the
high mass index in the human body exasperates the occurrence of musculoskeletal injuries due to
extreme physical exercises. This research investigates the use of non-opioid interventions for
pain medication.
Problem
The increased opioid use for pain management among veterans causes long-term risks
compared to non-opioid interventions. Research indicates that opioids should not be used long-
term, yet there is evidence of increased reliance beyond the prescription dosage (Phillips et al.,
2017). While opioids may be recommended for specific chronic pains, their use beyond the
prescription is the primary cause of the opioid crisis in the United States. There is an apparent
linkage of opioid prescriptions to their misuse (National Institute on Drug Abuse, 2021). This
outcome is primarily attributed to their ineffectiveness in pain management in the long run.
About 29% of those with opioid prescriptions misuse them for them as the pain is prolonged. In
addition, opioids have been linked to a high level of addiction among their users (Azadfard et al.,
2021). This outcome may be linked to its high misuse, which further enhances the abuse of
heroin; about 80 percent of heroin abusers first engaged in opioid abuse (National Institute on
Drug Abuse, 2021). This research further indicates that around 12% of those with opioid use for
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pain management develop an opioid disorder primarily associated with opioid addiction.
Therefore, the opioid abuse crisis can be dependent on the time engaged in its use; the longer one
engages in opioid use, the more the chances of developing an addiction or abuse of heroin and
other substances.
Current interventions may restrict the increase in opioid dependence yet enhance the
chances of secondary effects of its use. Various policies have been enacted in the United States to
tame the opioid crisis, which has not been effective. In this case, the introduction of PDMP
enhances the reduction of opioid misuse (Lee et al., 2021). This is the primary expectation of
introducing this policy to manage chronic pain for veterans and other Americans. With this
policy, prescribers may review the patient's prescription history before recommending an
additional dosage of opioids. Research indicates that this policy leads to a decreased use of
medically prescribed opioids yet increases the use of heroin as an alternative (Lee et al., 2021).
In addition to policies, stigma is another factor enhancing the opioid crisis in the United States.
Tsai and colleagues (2019) indicate that stigma against opioid reliance exasperates the opioid
crisis. In this case, stigma enhances withdrawal from substantive healthcare services. Increased
withdrawal from proper medical care leads to increased opioid mortality. In this case, relying on
opioids for pain management enhances the stigmatization of those using this technique.
Therefore, this may reduce their chances of seeking appropriate medical attention.
The relevance of this problem for a nurse anesthetist is centered on their role in managing
opioid use. Research indicates that nurse anesthetists are responsible for regulating opioid use for
pain management in healthcare (Edwards et al., 2020). In this case, if opioids must be regulated
for pain management among veterans, nurse anesthetists must be at the forefront of this
initiative. Patients rarely have control of what is being prescribed to them. It is the role of the
8
nurses to observe and mitigate the risks associated with potential opioid misuse through effective
prescriptions that would reduce the chances of opioid abuse. Nurse anesthetists can therefore
guide the implementation of alternative techniques to manage opioid misuse through the gradual
decrease in its use. There are many alternatives to opioid pain management techniques. Nurse
anesthetists may further prescribe these alternatives to reduce the reliance on opioids on veteran
chronic pain management. Therefore, nurses are central pieces in the implementation of opioids
for pain management among all patients. The problem addressed in this paper may guide their
understanding of the dangers surrounding opioid misuse and the long-term advantages of
recommending non-opioid interventions.
Clinical Questions
The paper's relevance is to address the clinical significance of using non-opioid
interventions for pain management and its long-term benefits as opposed to opioid use. While
opioids have been used to critically manage pain in the short term, their ineffectiveness has
introduced the need to have a more effective method to manage pain among veterans. Therefore,
the clinical question in this paper is given as the hypothesis: Non-opioid interventions for pain
management among veterans are effective in the long run compared to opioid modalities.
This
hypothesis will guide the comprehension of the fundamental clinical question that is being
addressed in this paper.
PICO Questions
The PICO questions for this paper are indicated in the following bullets as adapted from
the hypothesis above
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Population
Veterans who are diagnosed with chronic pain problems are the most suitable population
group for this assessment due to their increased rates of opioid overdoses in the United States
Intervention
Non-opioid modalities for pain management are the preferred intervention for the
problem facing the above population due to their effectiveness in the long run.
Comparison
Opioid interventions for chronic pain management in veterans are compared for their
effectiveness to the non-opioid alternatives to find a difference in the two's long-run
effectiveness and risk.
Outcome
Improved pain management and decreased opioid addiction and overdose is the
anticipated outcome of this assessment.
Specific Aims
This paper aims to address the effectiveness of non-opioid alternatives for chronic pain
management in the United States among the veteran population and compare this level of
effectiveness to the risks associated with opioid misuse for chronic pain management.
Methods
This paper will employ a systematic review as the fundamental method to investigate the
problem of opioid misuse and its long-run effects then indicate the benefits of increasing
emphasis on non-opioid alternatives for pain management among veterans in the United States. A
review of 20 scholarly articles from credible sources addressing the use of opioids and
alternative pain management modalities among veterans was preferred for this assessment. The
sources used were included in medical journal listings. This was a priority for the lection of the
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articles to increase the credibility of their findings before the investigation. In addition to this,
credibility was further determined by the author's credentials in selected articles and cited
references. In this case, the author's experience in medical research or practice was fundamental
to the selection of these articles. For articles without an author, its affiliation with reputable
medical sources was the preferred criteria.
The search strategy for the articles involved an effective selection of those matching the
established criteria of relevant articles for the research. This established criterion considered the
selection of specific keywords cogitated as necessary to this research. In this case, most of these
keywords were obtained from the hypothesis and the PICO questions to effectively guide the
selection of appropriate materials contributing to its intended outcome. Therefore, the search
involved Boolean operators and keywords in selecting the most relevant articles. These keywords
include "opioids" and "non-opioids" and "veterans" and "pain." These keywords enhanced the
selection of materials that investigated questions related to the aim of this research. In addition to
this, the articles matching this criterion were further screened for keywords in their abstracts. It
was a requirement that the articles containing an abstract have at least three of the keywords,
with "pain" being a mandatory keyword. For those without an abstract, these keywords were
screened through searching the document for their presence.
Review of the Literature
Overview
The use of opioids for chronic pain management has been widely adopted for veterans'
musculoskeletal injuries. Veterans are the most affected population in chronic pain in the
musculoskeletal area and other areas because of the intensity of challenges they endure in their
field of service. While opioids effectively reduce the pain experienced by these veterans on a
short-term basis, they may cause more harm in the long run. Therefore, many researchers
11
advocate for non-opioid modalities for improved pain management. They have a long-term and
more effective solution to pain management among veterans and other population groups
experiencing chronic pain.
Histopathology of Opioid Addiction
Opioid addiction has been a fundamental problem in the United States since its
introduction. According to the National Institute on Drug Abuse (2021), the distribution of
opioids increased in the US in 1990 due to its increased demand. This led to a negative outcome
where nonmedically distributed opioids further increased in the same year, as Phillips et al.
(2017) indicate. This shows that the US's increased use of opioids for pain management led to its
abuse through nonmedical distributions. Research attributes stigma as a fundamental cause of
opioid abuse (Tsai et al., 2019). In this case, stigmatization of those using opioids for pain
management causes their alternative seeking pain management techniques. While this is true, the
education level is further inversely correlated to opioid addiction and considering non-
pharmacological approaches to pain management (Edmond et al., 2018). Therefore, the opioid
addiction crisis can be attributed to sociological factors, which may be averted when non-opioid
alternatives are integrated into the pain management modalities among veterans in the United
States.
Opioid And Non-Opioid Use In Pain Management
In the occurrence of chronic pain among veterans, both opioid and non-opioid modalities
are effectively managed. However, research indicates that non-opioid use for pain management is
more effective than antagonist opioid modalities (Krebs et al., 2018). There is an antagonistic
relationship between opioids and non-opioids in pain management. Krebs et al. (2018) further
indicate that the pain management in non-opioid patients in their research study was more
12
effective than those in the opioid group. Other researchers have indicated that complementary
and integrative healthcare approaches such as yoga and acupuncture were effective in pain
management among veterans in the long run because of the decreased risks of developing
adverse health conditions such as addiction, as is the case of opioids (
Pain Management
, n.d.).
Therefore, there is increased effectiveness in utilizing non-opioid mechanisms for pain
management among veterans. The efficiency observed from research indicates that non-opioid
modalities may further reduce long-term engagement with opioids.
Opioids may be classified under addictive substances due to their interaction with pain
management which may stimulate further use and addiction. Research indicates that using non-
opioid modalities for managing chronic pain reduces the chances of long-term engagement with
opioid prescriptions (Carey et al., 2018). Despite this evidence, the increased use of opioids is
attributed to an increased urgency for pain management among veterans. Higgins et al. (2020)
indicate that among veterans diagnosed with MSD, and those who have a high BMI, there is an
increased pain intensity for musculoskeletal injuries. This may be why some researchers
recommend considering the patient's comfort and safety in using a multimodal approach in pain
management among veterans (Hsu et al., 2019). In considering this recommendation, other
researchers have indicated that non-invasive pain management devices were influential in
managing chronic pain among veterans (Morrow et al., 2019). Therefore, non-opioid
interventions are recommended to reduce the overall effects of addiction and misuse of opioids
for pain management.
Non-Opioid Interventions
The various non-opioid interventions for pain management among veterans may have
further adverse effects, but they do not supersede their benefits compared to opioid interventions.
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Non-opioid pharmacological interventions may be as effective as opioid interventions yet
enhance adverse events resulting from withdrawal from treatment (McDonagh et al., 2020). The
effects of opioid interventions on addiction and misuse have initiated the opioid pandemic that is
currently present in the United States. Research indicates that the complex social, psychological,
and biological factors enhance this outcome (Lee et al., 2021). This complexity can be further
observed in the use of non-opioid pharmacological interventions (McDonagh et al., 2020). These
interventions include medication that can help manage pain in veterans yet do not involve opioid
modalities. However, while the effectiveness of this method may be apparent, the non-opioid
non-pharmacological alternatives may be further effective in enhancing pain management among
veterans.
Effectiveness Of Non-Pharmacological Interventions
The non-pharmacological alternatives to pain medication may have enhanced
effectiveness when it comes to chronic pain management. In this case, research suggests that this
alternative may enhance a long-term benefit in pain management (Kaye et al., 2020; Skelly et al.,
2018). In addition to this, Voll et al. (2021) indicate that considering a biopsychosocial approach
to managing pain has been effective in pain management and an overall reliance of morphine
equivalent daily dose by up to 21 mg. To support these non-pharmacological alternatives, the
Veterans Health Association has recommended implementing multi-systems level programs for
chronic pain management (Frank et al., 2019). These systems include physical exercises and
therapy. In addition to this, Molloy et al. (2020) suggest that there has been an overall decrease in
musculoskeletal injury pain among veterans who undertake physical exercises as a pain
management technique.
14
The high effectiveness of non-opioid modalities for pain management further considers
modern pain management among veterans in the United States. Findings from the perioperative
questionnaire assessment indicate that 82 percent of patients involved in non-opioid pain
management modality were satisfied and had effective ways to manage pain (Alter & Ilyas,
2017).In addition, research indicates the high effectiveness of non-pharmacological interventions
in reducing the overall dependence on opioids (Daniels et al., 2019; Kaye et al., 2018). While
this effect is apparent, nurse anesthetics play a central role in enhancing this outcome. According
to Edwards et al. (2020), the fundamental role of certified registered nurse anesthetists involves
educating and supporting veterans against the misuse of opioids through recommending and
prescribing non-opioid alternatives. This strategy enhances the effectiveness of non-opioid
modalities in the management of chronic pain among veterans.
Summary and Conclusions
The increased effectiveness of non-opioid interventions for pain management in the
United States among veterans has more long-run benefits than its opioid alternatives. The
findings of this paper indicate that non-opioid alternatives are more effective compared to opioid
modalities in chronic pain management. In this case, the risks associated with using opioid
modalities in chronic pain management are more severe. Opioids have been linked to increased
abuse and addiction, which prolongs their use without long-run effectiveness in pain
management. On the other hand, non-opioid pain management has long-run effectiveness in pain
management among veterans. As BMI and other diseases are associated with accelerated
musculoskeletal injuries and pain, implementing non-opioid pharmacological and non-opioid
non-pharmacological interventions may guide treating veterans with chronic pain. Opioid
15
addiction is an epidemic in the united states that can be effectively reduced through initiating
non-opioid modalities as they have increased effectiveness against chronic pain in the long run.
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