Free Essay Sample on Deconstructing Chronic Pain Management

Intoduction

Letting a patient suffer due to prolonged pain is unethical, but do patients always have a right to their chosen chronic pain management method? Access to pain management options has been labeled as a human right, but medical practitioners also have the right to utilize their knowledge and say no to the patient's demands, especially when the chosen treatment option has potential side effects that can be avoided (Nieminen et al., 2015) There has been a rapid increase in prescription opioids since physicians feel compelled to prescribe them for chronic pain management despite increasing deaths due to overdosage (Cosio, 2014). Since the patient has the right to autonomy, the working alliance concept was introduced to balance the physician and patient's needs.

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Effective Communication

Patients with chronic pain deserve effective communication as they often receive contradicting advice on the best solutions to pain, thus can get confused about their options. Poor communication is likely to push the patient to lose track of their health or change doctors, making their management process harder, and reducing health outcomes. According to research done by Lim et al. (2016), patients who have disagreements with their doctors on medical decisions, especially treatment options, have lower health outcomes. To reduce the chances of misunderstanding while giving physicians the authority to choose alternative treatment for chronic pain management, technology has been used to bridge the gap. Healthcare facilities have adopted patient portals, personal health records, and telehealth tracking applications as patient-centered platforms to ease communication (Lim et al., 2016). Such platforms also task the patient with the responsibility of their health by tracking their activities when away from the hospital. For instance, for chronic pain management, a physician who prescribes exercise can monitor how disciplined the patient is when adhering to the prescription, which increases their qualitative and quantitative data on prescriptions, their effectiveness, and how readily they execute them contributes to their clinical expertise (Mohammadzadeh & Safdari, 2016). The adoption of technology reduces face-to-face interaction between patients and physicians. However, since interpersonal skills form an important part of the training of physicians; therefore, the use of technology has not entirely replaced face to face communication.

Using the Hamrick’s Model

Hamrick's model was developed in 1996 to address nursing practices based on leadership, collaboration, and evidence-based practices (Nieminen et al., 2015). When a physician says no to opioids, their decision should be based on the model, as it balances the thoughts of the patient and medic.

Collaboration is vital in healthcare since it cuts across departments (Fawcett et al., 2014). Between the period that the patient enters and leaves a facility, different experts, including medics and non-medics, are involved in the process; thus, proper communication and appreciation of each individual's role is essential for a smooth process. Miscommunication among nurses and doctors could also lead to confusion and medical errors or frustrate the patient. Evidence-based practice has become the guide of healthcare, as it is no longer based on traditional medicine and intuition. However, that does not mean that traditional medicine such as traditional Chinese medicine has been trashed, but is used in cases where scientific evidence is available. Evidence-based practice has three components: patient preferences, research, and clinical expertise. The three components aid a quicker and more accurate diagnosis and treatment or management.

In the management of chronic pain, clinical expertise is based on what the practitioner prescribes to other patients and their effects on different patients. The alternative prescription they choose instead of opioids will be based on experience with different causes of pain, age, gender, among other factors. Since what works in one patient may not be as effective for another, the practitioner will also use research to include or combine alternatives to increase health outcomes. Research on the body, mode of action of various forms of therapy, and their side effects will also determine the alternative. Additionally, patient preferences will be considered since they have a right to autonomy (Kilbride & Joffe, 2018). After consulting with the patient on their preferred option, the physician guides them based on research and clinical expertise on what will serve them best, but they must not compel them as long as they are of sound mind. For instance, if the patient insists on opioids despite the practitioner insisting on alternatives, they will be forced to offer opioids (Schneider & Schneider, 2018). However, the prescription will have an alteration such as reduced doses, combined with alternatives such as exercise; thus, the patient preference is considered, but the physician applies research and clinical expertise in the prescription.

Hamrick’s model also requires medical practitioners to be leaders who know what is best for the patients, staff, and organization as a whole. The clinical practice geared towards satisfying the patient and staff while attaining organizational goals should be the aim of a leader. Additionally, a leader balances their interest with others, therefore adheres to the ethics of medical practice.

Advanced Practice Nurses (APN) hold potential in the growth of advanced practice roles in chronic pain management. Using advanced nursing practices in clinical settings yields noticeable results and increases patient outcomes without necessarily prescribing opioids. Patient readmission and health-related costs have reduced, and health status and satisfaction increased in settings where APNs work (Cooke et al., 2018). According to Hamrick's model, APNs apply direct clinical practice in pain management by prescribing the drug and nondrug therapy. Drug therapy includes over-the-counter medicines such as ibuprofen and aspirin or tech-driven options such as electrical signals and radio waves or nondrug options such as acupuncture or massages. The nurse will consult with specialists who have handled a more extensive range of patients and decide what fits the patient best.

Hamrick's model encourages consultation and guidance for both the nurse and patient to ensure they explore all the available options. After the nurse has consulted with experts, they stand as a bridge between medical jargon and layman language. The nurse should explain to the patient why they should opt for acupuncture or exercise and not opioids in the easiest terms. When the patient understands why a medical practitioner advises an alternative therapy, they are likely to take personal responsibility to make it a success (Cooke et al., 2018). However, if they are not satisfied with the prescription, they will likely seek medical advice elsewhere or neglect the prescription. Choosing an alternative does not mean it is more effective; therefore, the nurse must convince the patient why it is necessary despite not being as effective as opioids. For instance, a patient may resist using acupuncture, citing concerns of the therapy being painful, whereas opioids present an almost painless option. As an expert in this case, the nurse must explain why the process is worth some pain.

Alternative Methods

The US alone consumes 80% of the world’s opioid medication despite accounting for 4.6% of the world’s population(Ligotti,2015). Doctors are also prescribing opioids for longer days. The average prescription length has increased from 13 days to 18 days in the last decade (Ligotti, 2015). Continued prescription increases the chances of abuse and overdosage; therefore, practitioners must prescribe alternative methods aptly. However, the process begins with changing the Americans' perception of pain and making them understand that alternative methods are as effective as opioids.

Acupuncture

Acupuncture has a Chinese origin but has gained popularity across the globe. The therapy involves injection with needles into the skin to stimulate muscles, connective tissue, and nerves. The injections restore balance in energy-carrying channels since the particular targeted points (acupoints) are near calcium exchange channels (Patil et al., 2016). Traditionally, the form of treatment was used to induce synthesis of endorphins, corticosteroids, thus accelerate the healing process. According to a study by the National Institute of Health, acupuncture is an effective therapy for chronic pain, especially in the neck and back (Vicker et al., 2018).

Nevertheless, acupuncture remains a controversial form of treatment since it is not evidence-based. Acupuncture is based on the flow of qi energy and meridians, which are non-medical terms. Although most medics do not follow the concepts, they still use acupuncture on specific parts of the body to relieve pain. Given that the effects of acupuncture last a longer time than opioids and side effects are rarely reported, acupuncture is relatively safer (Patil et al., 2016). The data represented in the table below details the type of pain and the effectiveness of acupuncture in its management.

Conclusion

The working alliance ensures the relationship between the two parties is maintained despite the medic saying no to opioids, thus reduces the chances of the patient seeking treatment from somewhere else and posing a risk of drug interactions that interfere with the pharmacokinetics and pharmacodynamics of drugs. Since chronic pain management requires the patient to visit the same practitioner over time, it is important to eliminate power struggles and stigmatization and foster trust and respect (Lim et al., 2016). A satisfied patient exhibits higher health outcomes; therefore, empathy is important when empowering the patient; thus, the practitioner must choose and explain the alternative chronic pain management options supported by evidence-based practices.