Improving Pain Management in Long Term Care - Essay Example

Introduction

The adoption of result-oriented and evidence-based practices in health care has led to the improvement of treatment by biomedical professionals. One of the issues that has come to light is improving pain management in long-term care. The easing of pain is a significant aspect of medical practice and passes for an ethical issue. The ethical principle of beneficence requires that medical practitioners take action to improve the situation of their patients and this includes easing of pain. Pain management is a branch of medicine that aims at easing the suffering of people suffering from chronic pain. The branch is interdisciplinary and requires the input of various players such as nurses, occupational therapists, physician assistants, clinical psychologists, pharmacists, and medical practitioners (D'Aquila, Fine, & Kovner, 2009). Long-term care is where a given person requires assistance in their physical or emotional needs for an extended period. These needs are many and range from essential activities such as walking to even more personal ones such as providing comfort and assurance. Often, people in long-term care suffer from chronic pain, hence the need for easing their suffering. The pain management branch is therefore dedicated towards them to ensure their quality lives. This paper is an in-depth study of the methods aimed at improving pain management in long-term care using an evidence-based approach

Pain

A classification based on where the pain occurs results in categories such as musculoskeletal, neuropathic and spinal pain disorders. Musculoskeletal pain affects the ligaments, muscles, tendons, and bones. Its leading cause is the wear and tear of the muscle from daily activities and, in others cases, trauma to the muscle tissue. Neuropathic pain mainly results from nerve damage or a malfunctioning nervous system. Many conditions can lead to this kind of pain including amputation, alcoholism, diabetes, chemotherapy, among many others. In most of the cases, this pain qualifies as chronic pain (Gatchel, McGeary, McGeary, & Lippe, 2014). Depending on the time frame of the pain, then it can be referred to as chronic or acute, among others. Doctors have defined chronic pain as any pain that lasts for about six months or more. It, therefore, becomes a part of someone’s life and has very many adverse effects on it. Other narrower categories include foot pain, knee pain, etc. Whichever the type, pain is a complex phenomenon which lacks a precise definition but which in simplification may be said to be a feeling that causes distress in people. It stems from potential or actual tissue damage and the medics mostly treat it as a symptom of an underlying condition.

People who require long-term care

Long-term care refers to a broad scope of services aimed at meeting the medical as well as the non-medical needs of those people living with various forms of disability or a chronic illness. It is intended for maximizing a patient’s quality of life. The most prominent target for long-term care is the elderly from sixty-five years of age and above. This group is highly susceptible to chronic pain. This vulnerability results from various conditions discussed below. The list of chronic illnesses that is accompanied by chronic pain is extensive and put into consideration in this paper.

Improving pain management

The Elderly

The elderly are also professionally known as geriatric patients. A high percentage of above fifty percent of the elderly population report having some pain that bothers them and which has been occurring for several months. In most cases, this pain is felt in more than one location and in a way results in decreased physical capacity. Pain in the elderly is classified pathophysiologically as either nociceptive or neuropathic in origin. It also may be mixed having both elements (Malec & Shega, 2015). A common cause is inflammation or musculoskeletal disorders. About a three-quarter of the elderly also suffer from a chronic condition such as arthritis, chronic lung disease, diabetes, or even heart disease further complicating the pain management process. One of the pain management methods is through medication. The most commonly used drugs include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and adjuvant drugs such as antidepressants. These drugs should be carefully administered to the elderly to avoid the effects that may arise out of the drug interactions. The issue of pain undertreatment is also a matter of discussion which requires improvement. This is particularly a problem for the elderly who suffer from the Alzheimer’s disease since there is a communication barrier due to significant linguistic and cognitive impairments. The under-treatment of pain leads to negative consequences on the quality of life of the elderly which result in social isolation, depression, anxiety, cognitive impairment, sleep disturbances, and immobility. The improved pain treatment, therefore, requires an individualized and thorough evaluation of each patient to identify their needs and maximize the outcomes while minimizing the side effects. In most cases, the medical prescriptions are preferred over physical therapy. Instead, a balance should be in place between the two. Physical therapy should be recommended in cases where it is more effective than medication. However, it should be understood some of the elderly might not be able to exercise. As much as the overdependence on medicine may be effective, it gives rise to adverse reactions that result from drug-to-drug interactions. These adverse drug events occur due to natural physiological changes in their bodies which are as a result of age (Malec & Shega, 2015). These changes include the slower oxidation rate in the liver which leads to the lengthening of the drug half-life. The absorption rate of some of the drugs is also inhibited due to a slower gastrointestinal tract. The following is a full description of the types of drugs that should be prescribed for improved pain management together with their adverse drug reactions and drug-to-drug interactions (Malec & Shega, 2015).

NSAIDs. The use of this prescription is widespread among the elderly for the treatment of musculoskeletal pain. Although highly favored in contrast to opioids, these drugs are associated with various risks such as renal or even heart issues. The drugs are also contraindicated with certain medications. Drug-to-drug reactions and adverse drug effects should also be prevented by paying close attention to the medical history of the respective patients. Gastrointestinal toxicity is also a risk in which case gastro-protective medication may be prescribed for those using NSAIDs in the long run (Gatchel et al., 2014).

Adjuvant analgesics. This type of medication should be prescribed due to the treatment of neuropathic pain. It is, however, important to note that these drugs are not meant to alleviate pain directly, but instead, they produce side-effects which assist in pain management. These adjuvant medications mostly include antidepressants. High doses are associated with adverse drug reactions which can lead to arrhythmia, sleep disturbances, sudden decreases in blood pressure and a loss in equilibrium that leads to an increase in falls and injuries (Gatchel et al., 2014).

Opioids. These are recommended for use only after both NSAIDs and adjuvant drugs fail to ease the pain. This caution is mainly due to their addictive nature which leads to substance abuse (Chou et al., 2015). Some typical examples of opioids include methadone, morphine, fentanyl, and oxycodone. Significant adverse drug effects include nausea, constipation, gastrointestinal complications, sleep disturbances, increased falls, respiratory depression, and death.

To improve the pain management in the elderly, therefore, it is essential for a medical professional to have a personal connection with each patient, to understand their needs. While many of the elderly can express their pain to their doctor, others cannot. Thus, even those with conditions such as the Alzheimer’s disease should be carefully monitored to ensure their comfort. One of the effective methods in such cases, discussed later in this paper, is nerve block therapy. Diagnostics nerve blocks should be used to identify the cause of the pain.

HIV/AIDS patients

Patients who have HIV/AIDS face an increased rate of chronic pain which is mostly as a result of periphery neuropathy. Causes of this pain include the side effects of HIV medication, lowered immunity, and inflammation caused by the infection. The origins of neuropathy are varied and could either result from HIV itself or HIV treatment. In the case of the virus, changes occur in the central and peripheral nervous system although the "cause and effect" relation requires extensive study. The existing research, however, reveals that neuronal injury results in the apoptotic death of sensory neurons. The other causes of neuropathy are comorbid conditions and medications such as antiretroviral therapy. Common risk factors of peripheral neuropathy in HIV patients have been issued, including a low CD4 count of less than a hundred cells per mm3, high viral loads of more than ten thousand copies per ml, and advanced disease (Surratt et al., 2015). Others also include a history of neuropathies, nutritional deficiencies, history of tuberculosis, and diabetes among several others. The cause can, therefore, be regarded as multifactorial. Peripheral neuropathy is characterized by symptoms that include aching, stabbing pain, numbness, burning, and reduced temperatures and vibration sensation in the toes and hands. Therefore a brief evaluation of this condition requires asking the patient about distal numbness and checking for ankle reflexes.

Pain medications should include NSAIDs such as ibuprofen which assists in pain management for both persistent inflammatory and non-inflammatory peripheral neuropathy. The use of these drugs, however, has adverse drug effects such as abdominal pains, bleeding, renal and hepatic impairment, and platelet aggregation abnormalities. For more safety profile, acetaminophen is preferable as the first-line analgesia in non-inflammatory and mild peripheral neuropathy. Antidepressants such as nortriptyline and amitriptyline also ease pain from the condition, especially where patients are not responsive to NSAIDs (Surratt et al., 2015). They are also prescribed for patients with comorbid depression. Other pain medications include anticonvulsants such as gabapentin, pregabalin, and lamotrigine. Muscle relaxants such as cyclobenzaprine and baclofen are useful as adjunctive therapy for acute back pain. Opioids are however not recommended and should be only considered as a last option. This approach is due to the risk of dependence either accidentally or deliberately (Chou et al., 2015).

Cancer

As it is well known, cancer diseases involve abnormal cell growth which may invade or spread to other parts of the body. Cancer pain usually occurs when the cell growth presses on nerves or body organs. It can also be felt when cancer cells invade bones or body organs. Other sources of pain include the various types of treatments including chemotherapy, radiation, and surgery (Gatchel et al., 2014). One of the broad classifications of cancer pain is pathophysiology. Further division results in pain caused by ongoing tissue damage also known as nociceptive and pain caused by nervous system dysfunction, known as neuropathic pain. Psychological factors and comorbid psychiatric conditions such as depression can also result in chronic pain. Chemotherapy treatment has its side effects, some of which results in constant pain. Headaches, stomach aches, muscle pain, and pain from nerve damage. Ultimately, chemotherapy may lead to peripheral neuropathy. It is also common to experience pain after surgery which lessens as the body heals (Greco et al., 2014).

Pain management options should include prescription medications, implanted pain pumps, nerve block therapies, and physical therapy. Acupuncture and auriculotherapy, massage therapy, and chiropractic treatment can also be applied to pain management. Prescriptions should consist of opiate pain relievers such as morphine. Other prescriptions include anticonvulsants, anti-inflammatory drugs such as Prednisone, antidepressants, local anesthetics, and bisphosphonates such as Pamidronate. Medical marijuana prescription has also gained extensive usage to relieve cancer pain and is available in various ways such as marijuana cigarettes and dronabinol. Implanted pain pumps are a method of giving medicine directly to the spinal cord. Such a system utilizes a small pump surgically placed under the skin of the abdomen. A catheter then delivers medication to the areas around the spinal cord. It should be used for pain treatment where all other traditional methods have failed to relieve chronic pain. Its advantage is that the level of dosage needed is smaller and the side effects associated with oral medication is avoided (Greco et al., 2014).

Nerve block therapy is the use of nerve-numbing substance referred to as a nerve block. This medication is injected into a specific area to prevent pain in a given body region. The kinds of nerve blocks include therapeutic nerve blocks which contain a local anesthetic used to treat painful conditions. Diagnostic nerve blocks are very useful to determine sources of pain. Preemptive nerve blocks are used during procedures to prevent subsequent pain. The different kinds of nerve blocks should be used according to the different areas of pain (Gatchel et al. 2014).

Physical therapy is also very useful in relieving pain. Physical therapists identify the area affected by pain and determine the best exercise to ease the pain. Chiropractic treatment manly targets the spine and tries to correct the body’s alignment to relieve pain. Massage therapy has also been found to be very useful for pain relief including chronic lower back pain, chronic tension headaches among others. Acupuncture which involves stimulating specific points on the body by inserting thin needles into the skin has also been found to help relieve chronic back pain.

Conclusion

The list of conditions that require long-term care is non-exhaustive including diabetes mellitus, Alzheimer’s disease, autoimmune diseases, bipolar disorder, cerebral palsy, depression, and endometriosis among many others. However, they share most of the pain management processes. The pain management branch of medicine continues to make more inventions aimed at relieving pain. These interventions ensure that the elderly, HIV/AIDS patients, cancer patients, and all those people living with long-term conditions get to live a quality life that is free from pain. The best way of improving pain management is to conduct a quality and thorough personal evaluation for each patient to understand their individualized needs. Even more critical is a follow-up to access pain management effectiveness through evidence-based practices.