The Impact of a Clinical Practice Problem on the Patient
Chronic pain is a problem affecting millions of patients globally on a daily basis. Its conventional therapies include pharmacologic treatments, the most notable one being the use of opioids. However, there are immense risks associated with the chronic use of opioids due to the likelihood of addiction and overdose. Currently, there is an opioid use crisis coupled with an increasing number of opioid-related deaths in the United States. These factors have necessitated the need for alternative chronic pain therapy. The majority of the non-pharmacologic alternatives to opioid therapy are either not effective in alleviating chronic pain or have adverse effects and risks, including gastrointestinal bleeding. It is, therefore, important to evaluate alternative treatments like acupuncture, tai chi, hypnosis, CES, OMPT, and chiropractic care as a means of establishing a safe and holistic way of managing pain.
The PICO Question
The PICO Components of the Clinical Practice Problem
- P: Patients with chronic pains
- I: Alternative treatments (Acupuncture, tai chi, OMPT, chiropractic care)
- C: Opioids
- O: Reduction of chronic pain
An Evidence-Based Practice (EBP) Question Based on the Clinical Practice Problem
In patients with chronic pain, are alternative treatments like acupuncture, tai chi, OMPT, and chiropractic care more effective than opioids in reducing pain?
A Research-Based Article That Answers the EBP Question
The selected research paper for this section is “Fear of analgesic side effects predicts preference for acupuncture: a cross-sectional study of cancer patients with pain in the USA” by Liou et al. (2020).
The Background of the Research-Based Article
Under-treatment of chronic pain is a major challenge among cancer patients, which, among other things, compromises cancer patient outcomes and survival. According to Liou et al. (2020), one out of two cancer patients is under-treated for pain in different care settings. Opioids which are the mainstay for managing cancer pain, are not preferred by many patients due to fear of addiction and the potential side effects of using them. Additionally, opioids have also been associated with the inadequate alleviation of chronic pain symptoms. These attitudinal issues have been worsened by the increased mortality and morbidity associated with the use and misuse of opioids around the globe. Even though acupuncture is a recommended non-pharmacologic therapy for cancer pain management, a paltry 10% of the patients utilize it. Even though studies have been conducted on attitudinal barriers to pain management, they mostly focused on opioids and other analgesics. The researchers could not establish whether the attitudinal barriers also affected the take-up of acupuncture as an alternative to opioids in chronic pain management. The purpose of the research was to examine the association between acupuncture preference and attitudinal barriers to pharmacological pain management.
The Research Methodology Used in the Research-Based Article
The study entailed a cross-sectional survey of cancer patients in Pennsylvania and New Jersey. The selected patients were those who had undergone cancer diagnosis of any type and reported non-zero severity on a 0 to 10 scale in the past week. For the dependent variable, the patients were asked about their level of preference for acupuncture or pain medication in managing pain. Next, to examine the attitudinal barriers to pharmacologic pain management (independent variable), the researchers used the Barriers Questionnaire (BQ-13). Additionally, the researchers asked the patients whether they preferred acupuncture or analgesics or whether they had no preference between the two modes of managing pain. The covariates included clinical characteristics, sociodemographics, and beliefs/attitudes toward acupuncture.
The Level of Evidence in the Research-Based Article
According to the JHNEBP model, the article is at Level III in the evidence levels.
How the Researcher Analyzed the Data in the Research-Based Article
The researchers used STATA to analyze the data and presented the descriptive statistics as means and frequencies. They also analyzed the independent variable, which is the BQ-13 scores, as a continuous variable. The dependent variable, socio-demographics, and pain medication were dichotomized to ease interpretation. Next, the researchers performed a bivariate regression analysis to establish if attitudinal pharmacological pain management and other covariates affected acupuncture preference. The covariates with a P-value of less than 0.10 were included in the multivariable regression analysis.
The Ethical Considerations of the Research-Based Article
Firstly, the researchers obtained informed consent from all the participants in the study. Secondly, the researchers performed all the procedures that entail human participants according to the ethical standards of the national and/or institutional research committee, adhering to the 1964 Helsinki declaration, its later amendments, and comparable ethical standards. Lastly, there was no conflict of interest in the study from the funding of Dr. Jun J. Mao since the grants from two companies advanced to them were not related to this work.
The Quality Rating of the Research-Based Article
The quality rating of this article is A High Quality.
The Results of the Research-Based Article
According to the results, about a third of the respondents (31.4%) reported that they preferred acupuncture for pain management. This percentage is way above (three times) the one available in the literature reviewed by the researchers, which set the uptake of acupuncture in pain management at 10%. These results imply, therefore, that there has been an increase in the number of people preferring non-pharmacological interventions in chronic pain management.
How the Article Helps Answer the EBP Question
The article helps in answering the EBP question by providing evidence-based results on barriers to opioid use and increasing preference for alternative therapy (acupuncture) in chronic pain management.
A Non-Research-Based Article That Helps to Answer the EBP Question
The selected article is “A Comprehensive Review of Alternative Therapies for the Management of Chronic Pain Patients: Acupuncture, Tai Chi, Osteopathic Manipulative Medicine, and Chiropractic Care” by Urits et al. (2020).
The Background of the Non-Research-Based Article
Alternative therapies can serve as effective pain management modalities in the clinical setup, including acupuncture, chiropractic, osteopathic manipulative treatment, and Tai chi. According to Urits et al. (2020), profound research has been done, dictating the varying effectiveness of alternative treatments for chronic pain management. The purpose of this article was to comprehensively review and update the evidence-based alternative therapies used in chronic pain management.
The Type of Evidence Used in the Non-Research-Based Article
This article is a clinical practice guideline, which was achieved through a systematic review of evidence and assessment of the benefits and potential harms of alternative chronic pain management options.
The Level of Evidence in the Non-Research-Based Article
The level of evidence of the non-research-based article in the JHNEBP model is Level III.
The Quality Rating of the Non-Research-Based Article
The quality rating of the article is A High quality.
The Author’s Recommendations in the Non-Research-Based Article That Help Answer the EBP Question
The researchers recommended additional longitudinal studies to evaluate the role of alternative therapies in chronic pain management since there are mixed results on the evidence of their effectiveness. This article, therefore, does not give a conclusive answer on where alternative therapies can replace opioids when it comes to chronic pain management. Nevertheless, alternative treatments can be used as adjuvant therapies, with the potential to reduce the patient’s need for opioids.
A Practice Change That Addresses the EBP Question
From the research-based article, there are an increasing number of people who are opting for acupuncture (alternative therapies) instead of opioids. However, from the non-research-based article, there are mixed results on the effectiveness of alternative therapies in dealing with chronic pain. It is important that alternative therapies like acupuncture be included in the comprehensive clinical care of chronic pain patients.
Involvement of Stakeholders in Supporting the Practice Change Recommendation
The patients would be educated on the need to have alternatives as far as chronic pain management is concerned and the need to include it as an official healthcare alternative payable through insurance premiums. I can involve the providers in discussing the increased need for alternative therapies, and developing relevant policies, protocols, and practices related to offering alternative therapies. I would involve the payers by developing proper insurance products related to alternative chronic pain management to ease the burden of paying for alternative therapies.
A Barrier to Implementation of the Practice Change Recommendation
Policy rigidity is the major barrier that I may counter in trying to implement the practice change recommendation. It is not easy to convince policymakers to draft the relevant policies to grant alternative healthcare space in healthcare. Most policies are developed when there are conclusive studies on a specific health issue. However, the two articles are not sufficient to effect a policy change.
A Strategy That Could Be Used to Overcome the Barrier
One of the strategies that can be used in overcoming the barrier is by identifying more recent research on the issue and looking at the success of other developed countries in the use of alternative medicine. The main outcome that can be used in measuring the practice change is more patients experiencing a reduction in chronic pain after the use of alternative therapies.
References
Liou, K., Trevino, K., Meghani, S., Li, Q., Deng, G., Korenstein, D., & Mao, J. (2020). Fear of analgesic side effects predicts preference for acupuncture: a cross-sectional study of cancer patients with pain in the USA. Supportive Care In Cancer, 29(1), 427-435.
Urits, I., Schwartz, R., Orhurhu, V., Maganty, N., Reilly, B., & Patel, P. et al. (2020). A Comprehensive Review of Alternative Therapies for the Management of Chronic Pain Patients: Acupuncture, Tai Chi, Osteopathic Manipulative Medicine, and Chiropractic Care. Advances In Therapy, 38(1), 76-89.