Acute Pain Management: A Brief Overview Course Number, Section, and Title

(Example: NURS 4000 Section 04, Research and Scholarship for Evidence-Based Practice)

(enter the date submitted to Instructor)

CHANGE IN PRACTICE

Acute pain management is a difficult task to manage in most hospitals and other medical facilities. Patients may exhibit opioid addiction behaviors and some medications meant to alleviate acute pain may (in the end) increase pain. The purpose of this assignment is to highlight current ways hospitals and other medical facilities deal with needs of acute pain patients.

Acute pain management has become a growing problem in the modern world. Patients with acute pain have become used to certain medications and some have shown opioid addiction leading to accidental deaths and prescription abuse. Modern practices have included interviewing techniques as well as physical assessment to help competently evaluate and manage patients that complain of acute pain.

Emergency rooms, a hot bed for acute pain patients, has also seen a change in how to not only deal with acute pain, but also avoid potentially negative consequences like addiction. Examining first where the likelihood of acute pain will occur like in an emergency room or post-surgery, will allow medical professionals to assess and understand what acute pain in patients looks like. With over 45% of patients in emergency departments reporting acute pain and 46 million Americans undergoing surgical procedures annually, acute pain management is a problem that must be handled.

As earlier mentioned, opioid addiction is a prevalent dilemma in the United States and organizations like the ASPMN or American Society for Pain Management Nursing and the APS or American Pain Society has taken steps to improve pain management in the United States and circumvent potential addiction. These have included publication and formulation of pain-related position statements as well as clinical practice guidelines. Researchers have also stepped in to provide evidence-based approaches that show positive results in acute pain management.

Practice Change

Low-dose ketamine for acute pain, especially post-operatively may be a possible solution for pain management. It has decades of research backing it. The medical profession has utilized LDK for almost 4 decades and has played a role recently in providing patients with acute pain relief without the opioid associated adverse effects. Recent research has identified the frequency of dosing and amount per dosage to achieve the desired effect of acute pain relief.

People suffering from acute pain are frequently given opioids that are not only habit forming, but may generate more pain once off them or the patient gets used to them. Although low-dose ketamine is given via iv and intramuscularly, it prevents people from overdosing, or if hospital staff administer the medication, it prevents people from getting a higher dose than needed. Patients truly needing acute pain management will then experience pain relief without possible addiction and/or overdosing.

Low-dose ketamine also prevents opioid addicts from getting pain medication that they can then take home or pain medication that will give them a "fix." Since LDK must be administered via IV and at small doses, an addict will not get what they want from such administration of pain medication. It can deter such behavior as well as ensure those that do need acute pain management are treated. Furthermore, LDK can be used effectively in conjunction with other pain management medications or local anesthesia that is generally used for surgery.

Evidence Supporting the Proposed Change

Successful application of any acute pain management protocol or service comprises of a team method in which group members have plainly defined roles. "Clinical protocols are designed to help address common problems and prevent errors. As the complexity of surgery and patients' diseases continues to increase, current knowledge of new analgesic medications, acute pain literature, and skills in regional anesthesia techniques is imperative" (Schwenk, Baratta, Gandhi & Viscusi, 2014, p. 893). In order for treatment regimens that include options like low-dose ketamine, clinical protocols must be formulated to include assessment and prevention of errors. If medical staff have comprehensive knowledge of pain medications, their side effects, as well as possible interactions, it may help in turn provide higher quality of care. Assessment include getting adequate patient histories including prior use of opioids and other medications that may interact with opioids like anti-depressants.

Opioids although a popular method of pain management has it negative effects. One such negative effect is opioid-induced hyperalgesia. "Opioid-induced hyperalgesia is a phenomenon defined by increasing pain after opioid exposure with the worsening of pain occurring when opioid doses are increased. Hyperalgesia has been described following remifentanil and morphine use, but the question remains about...

153). Morphine use as a pain reliever is quite common in emergency room care. However, because of the aforementioned phenomenon, it should be considered less frequently and instead other options should be examined.
Communication is important in acute pain management. Assessment and evaluation cannot take place unless communication happens. Smith et al., explained in their article the need for regular communication in a healthcare setting, especially for potential risks for opioid addiction.

Patients with positive experiences commented on regular communication with their care team, rapid pain management, and the empathetic nature of their care providers. Patients communicate fears about the risks of opioid addiction, beliefs that following a prescribed opioid regimen is protective of developing opioid dependence, and an understanding of the broader tensions that providers face relating to the prescription of opioid therapy (Smith et al., 2015, p. 00232).

Like LDK, other pharmacological therapies have also been shown to be highly effective for specific pain modalities. These include the use of antidepressants for patients experiencing musculoskeletal pain, for postsurgical pain and neuropathic pain; -aminobutyric acid agonists were useful. Patients experiencing headaches can be treated with antipsychotics. Topical capsaicin may be useful neuropathic pain. "Nonpharmacological methods of pain control include the use of electrical stimulation, relaxation therapies, psychosocial/manipulative therapies, and acupuncture" (CV & ER, 2015, p. 36).

Low-dose ketamine or LDK may be an option for treating acute pain in an emergency setting as well as a post-operative surgical setting when combined with other pain management medications. "Use of LDK as an analgesic in a diverse ED patient population appears to be safe and feasible for the treatment of many types of pain" (Ahern et al., 2015, p. 197). So many research articles highlight the efficacy of LDK for pain management. However, this recent one also specifically states its efficacy in the emergency department setting where almost half of the case require acute pain management.

Since opioid addiction remains a big problem for those in the healthcare community, and there is a stigma attached to opioid medication administration, potential acute pain management issues may arise. Like the majority of hospital inpatients, those with OUD or opioid use disorder frequently experience acute pain throughout their hospital stay. In addition, they may need opioid analgesics. "Unfortunately, owing to clinicians' misconceptions about opioids and negative attitudes toward patients with OUD, such patients may be inadequately medicated and thus subjected to unrelieved pain and unnecessary suffering" (Paschkis & Potter, 2015, p.1). What remains a problem then is providing adequate screening protocols to provide patients with adequate acute pain management. Previous effort on postoperative pain paths have observed pain score variations over time utilizing daily averages of written pain scores. Nevertheless, little is known concerning the time necessary until patients constantly report nominal postoperative pain. "We defined SuPPR as the time required until a patient reports the first of multiple (2, 3, 4, or 5 sequential measurements; e.g., SuPPR-2, SuPPR-3, etc.), uninterrupted, mild pain scores (?4/10). SuPPR may represent a novel method for evaluating acute pain service performance" (Tighe, King, Zou & Fillingim, 2015, p. 1).

Evaluating the Change

Acute pain management via LDK as standard protocol will be evaluated via patient satisfaction surveys both while being treated and during a follow-up appointment. Patients exhibiting marked improvement will solidify the efficacy of LDK either as a singular treatment for acute pain or as a supplementary treatment along with other acute pain treatments. Neutral feedback will allow for pursuit of further improvements. If patients demonstrate negative feedback, dosages as well as examination of combination of treatments and patient problems will be assessed in order to provide a higher quality of care for acute pain patients.

Things to look out for in the assessment in regards to negative feedback is source of pain in the patient as well as where the patient was treated. Patients having difficulty with pain after surgery and patients exhibiting pain in an emergency department may have different types of pain. Assessing these individual instances will allow for an overall clearer picture of LDK efficacy in particular settings. Surveys will include agree/not agree statements, a 1-5 rating on pain, and various yes or no statements in relation to feeling pain or not after medication was administered and finally one last question asking where the person was treated and for what.

Patient showing pain especially in the survey involving follow-up appointments will be assessed for illnesses or injuries that may have led to chronic pain. Chronic pain unlike acute pain will…