Chronic Pain Management among the Elderly and Drug Addicts
Background.
Pain refers to undesirable and uncomfortable feeling that the patients undergo due to injury or damage to the body tissues. Nurses form a critical group that is tasked with the role of pain management which is usually aimed at creating comfort as well as enhancing the quality of life that the patient is living. In this case, chronic pain in one that persists for more than six months and can reoccur once in a while. This reverse of the acute pain which disappears with control. According to Kress et al, (2014) two groups of geriatric and the drug addicts are special in that they have altered pharmacodynamics and pharmacokinetics.
Untreated pain amongst the elderly is extensive and need to have a change in its approach. This is so because its assessment is wanting hence challenge its management. It is this situation that prompted Rastogi & Meek(2013) to foresee the need for a pain management care plan that is individualized since the pain varied amongst people and was expressed differently.
On the other hand, the management of chronic pain among the drug addicts is also challenging in that most of the drugs are used for pain medication are opioids, yet the drugs that they are addicted to are also opioids. The challenge creeps in as it is difficult in determining dependency, addiction or amount required to meet the therapeutic level since the blood levels of these drugs are high.
Problem statement.
Despite presence of both pharmacological methods of pain management such as use of opioids, non-steroid anti-inflammatory drugs and other prostaglandin blockers as well as non-pharmacological methods ranging from music therapy, art therapy, acupuncture and hydrotherapy, the management of chronic pain has remained challenging amongst the geriatrics as well as the addicts of substance use(Abdulla et al., 2013). The concern placed on pain management on in the peri-operative period has been extended to cover the pain among addicts and the elderly due to the various features that make them unique and vulnerable to poor management of pain by the medical team.
With the various conditions that the geriatrics experience, they are predisposed to polypharmacy which leads to both drug interaction and drug resistance. This may also render the pain medication ineffective to achieve its intended purposes. Moreover, aging comes about with reduced functions of various body systems and organs. This also tampers with the pharmacokinetics of various drugs hence may not achieve the therapeutic level of the analgesics and continue experiencing pain especially where there is total organ failure.
For the drug addicts, they may not easily attain the therapeutic levels of analgesics in their bodies that can relive them of the chronic pain since they have developed tolerance to the drugs and can only benefit from them at very high doses. These high doses are also detrimental health wise since the side effect also increases with the dosage. Since the healthcare providers are mandated with pain care, a dilemma exists to differentiate between addiction, dependency, and need of the analgesics for the pain p management. Beside all these challenges, the nagging by these patients throughout may create stigma as they may be perceived to be attention seekers, rejects as well as burden hence assumed yet they might be in real need of pain control. In the long haul, the pain control process gets tampered with.
Purpose of the change proposal
The challenges that face both the elderly as well as the drug addicts call for change that is purposed to assist in providing meaningful and effective pain care to these two groups to ensure they attain a better quality of life. The reason for the change in their chronic pain management also extends to enable nurse get to know these challenges and apply other tools in considering and assessing their situation and alleviate them from the suffering.
PICOT
Population.
This article concentrated on the geriatrics and the drug addicts due to their unique features that make them vulnerable to mismanage care provision. These include, the geriatrics having most of their organs and system less functional hence not meeting the pharmacodynamics and missing to get the therapeutic levels of the drug (Galanter, Kleber & Brady, 2014).
Pain management has called for the concern primarily on the care for patient perioperative, the geriatrics as well as those addicted to substance use. Without pain management, these groups encounter a reduced quality of life and even exacerbate their medical conditions. With the healthcare providers tasked with care to patients, pain care to both the geriatrics and drug addicts have suffered less attention concerning provision of objective pain assessment and implementation of strategies that aim at alleviating the patients of their discomfort.
Intervention.
Successful pain control requires proper pain assessment following a physical examination and history taking which can provide the healthcare provider with a basis of intervention. History taking is significant since it gives an individualized care that can be able to determine the years of substance abuse to the addicts. The physical examination can determine the functionality of various body organs. It is also essential for various care centers to develop new pain evaluation methods that can determine opioid use, drug tolerance as well as toxicities that can be present among the elderly and substance users.
Comparison.
With the implementation of the pain assessment tool, the outcome will be evaluated, and education and training also enhanced among the nursing staff. The tool of reference will have components aiming to determine risks of drug tolerance, toxicities as well as the effective pain case to the geriatric as well as drug addicts (Vowles et al., 2015). The outcome of the pain management will be compared with other units with the same population consisting of the elderly and substance users and pain management compared.
Time.
Implementation of the personalized pain evaluation and management tool will be followed by evaluating the overall change in the pain control. Collection of the data will take two months with questionnaires administered during the discharge period to determine the effectiveness of the pain care.
Literature search strategy employed
The determination of the information concerning pain management among the geriatrics and the substance users were obtained via electronic search in the Google scholar resources for all the literature that was published from the year 2013. The literature were all published in English with various reviews constructed on relevant articles.
Evaluation of the literature
The literature gave a precise description of the problem at hand ranging from the origin of the issues and attributing factors. These included the features that make the geriatric and the drug addicts being vulnerable to poor pain management ranging from altered pharmacodynamics and pharmacokinetics that interferes with the achievement of the therapeutic levels of analgesic that is usually administered.
Applicable change or nursing theory utilized
The appropriate nursing theory in pain management for the geriatrics and the drug addict is the Dorothea Orem’s theory of self-care deficit. This is so because, with pain, all these patients will have reduced functional ability hence won’t be able to carry out some of the duties of daily living. The nurse comes in to assist the patients in meeting their needs, and since these will require pain alleviation, the chronic pain management for the group comes in. The Orem’s theory is also fit in that it provides for rehabilitation which is a crucial issue to these groups.
Proposed implementation plan with outcome measures
Personalized assessment too and pain management will be applied with comparison done with patients of the similar characteristic in other units for pain management. The tool will concentrate on determining the risk that the geriatrics and substance users are predisposed to that affect the management of their chronic pain.
There exists a probability of the increased number of people who will achieve the substantial pain management with the implementation of the personalized pain assessment and management tool. This is so because their care is based on evidence-based practice and patient-centered (Peisah et al., 2014)
Potential barriers to planning implementation, and how to overcome them.
The implementation of personalized and patient-centered pain assessment and management may be curbed by the incompetency of the nurses who may not be familiar with such tools. This will be catered for by participating in in-job training and education to equip them with the knowledge on the use of the tool. At the same time, being knowledgeable of the expected practices can also overcome the resistance which is also a potential barrier to the implementation of the new assessment tool.
References:
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Galanter, M., Kleber, H. D., & Brady, K. (Eds.). (2014). The American Psychiatric Publishing
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