Description
This assigment comes in 3 part. Parts 1, 2 and 3 are discussiones and will need 250-300 words and 1 reference, also 2 peer responses each one of 100-150 words and 1 reference.
Part 1 Discussion:
When you develop a research project, you need to have a reliable and valid method of measurement in your study. Using your anticipated research proposal, how will you address the issues of reliability and validity? What concerns do you have over reliability and validity in your study and how will you overcome these concerns? Next, read two of your classmates’ posts and analyze how they addressed reliability and validity in their studies. Do you have any recommendations for improving reliability and validity?
Part 2 Discussion
Appropriate sampling is a critical component in developing a good research project. Using your approved research questions and research topic, explain your anticipated sampling method and why this is appropriate for your research proposal. What is your sample size? Next, read and review two of your classmates’ posts and analyze their sampling approach. Are their sampling approaches appropriate? Why or why not?
Part 3 Discussion
Discuss how evidence-based guidelines shape APRN practice.
Are physicians (MDs and Dos) and APRNs held to the same evidence-based standards?
Are APRNs independent and autonomous providers just as physicians (MDs and Dos)?
What are collaborative agreements between physicians and APRNs?
Are NPs required to pay physicians so they can practice?
How do APRNs incorporate consultation and collaboration with their supervising physicians?
Support all responses using at least one scholarly source other than your textbook.
Use national guidelines and evidence-based research when applicable.
Students may enhance responses with an example, either from personal experience or from the media, which illustrates and supports ideas.
All sources must be referenced and cited using the correct APA format (including a link to the source).
I have also attached the PICOT stament proposal from week 1 for you to review it. I need you to follow the model that I have included since the instructor was not very happy the way we did it.
Unformatted Attachment Preview
Template for Asking PICOT Questions
INTERVENTION
In ____________________(P), how does ____________________ (I) compared to
____________________(C) affect _____________________(O) within ___________(T)?
THERAPY
In __________________(P), what is the effect of __________________(I) compared to
_____________ (C) on ________________(O within _____________(T)?
PROGNOSIS/PREDICTION
In ______________ (P), how does ___________________ (I) compared to _____________(C)
influence __________________ (O) over _______________ (T)?
DIAGNOSIS OR DIAGNOSTIC TEST
In ___________________(P) are/is ____________________(I) compared with
_______________________(C) more accurate in diagnosing _________________(O)?
ETIOLOGY
Are____________________ (P), who have ____________________ (I) compared with those
without ____________________(C) at ____________ risk for/of
____________________(O) over ________________(T)?
MEANING
How do _______________________ (P) with _______________________ (I) perceive
_______________________ (O) during ________________(T)?
Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.
Short Definitions of Different Types of Questions
Intervention/Therapy: Questions addressing the treatment of an illness or disability.
Etiology: Questions addressing the causes or origins of disease (i.e., factors that produce or
predispose toward a certain disease or disorder).
Diagnosis: Questions addressing the act or process of identifying or determining the nature and
cause of a disease or injury through evaluation.
Prognosis/Prediction: Questions addressing the prediction of the course of a disease.
Meaning: Questions addressing how one experiences a phenomenon.
Sample Questions:
Intervention: In African-‐American female adolescents with hepatitis B (P), how does
acetaminophen (I) compared to ibuprofen (C) affect liver function (O)?
Therapy: In children with spastic cerebral palsy (P), what is the effect of splinting and casting(I)
compared to constraint-‐ induced therapy (C) on two-‐handed skill development (O)?
Prognosis/Prediction:
1) For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to
not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season
(T)?
2) In patients who have experienced an acute myocardial infarction (P), how does being a
smoker (I) compared to a non-‐smoker (C) influence death and infarction rates (O) during the
first 5 years after the myocardial infarction (T)?
Diagnosis: In middle-‐aged males with suspected myocardial infarction (P), are serial 12-‐lead
ECGs (I) compared to one initial 12-‐lead ECG (C) more accurate in diagnosing an acute
myocardial infarction (O)?
Etiology: Are 30-‐ to 50-‐year-‐old women (P) who have high blood pressure (I) compared with
those without high blood pressure (C) at increased risk for an acute myocardial infarction (O)
during the first year after hysterectomy (T)?
Meaning: How do young males (P) with a diagnosis of below the waist paralysis (I) perceive
their interactions with their romantic significant others (O) during the first year after their
diagnosis (T)?
Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.
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Non-Pharmacological Chronic Pain Management: Literature Review
Name
West Coast University
NURS 540 Research Utilization
Dr.
January 17, 2024
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Non-Pharmacological Chronic Pain Management: Literature Review
Pain management is an essential feature of the clinical process as it determines the
patient’s quality of life, experience of care, and independence. Chronic pain management
remains a challenge for many patients across the country. Most people with chronic pain acquire
opioid prescriptions for pain management and even when managed well, opioids still pose a risk
for dependence and substance abuse. Non-pharmacological alternatives have been considered
and used as adjuvants for chronic pain management as a means of reducing dependence on
opioids. This literature review outlines the current research on the effectiveness of nonpharmacological pain management options for chronic pain compared to opioids.
Systematic Reviews on Different Chronic Pain Conditions
As a general research area, three systematic reviews all focusing on different health
conditions have been selected for review. The first one by Grassini (2022) is a systematic review
and meta-analysis of evidence on virtual reality (VR)-mediated non-pharmacological pain
management for neck and low back pain. The researchers obtained nine randomized controlled
trials (RCTs) and reported significant neck pain reduction but non-significant impact on chronic
low back pain. Despite the potential therapeutic benefits, Grassini (2022) demonstrates that the
evidence on VR is inconclusive. The main limitation with this study is that it is focused on neck
and low back pain only. Further analysis of VR with other forms of chronic pain is needed and
more RCTs are required to provide more reliable findings on the non-pharmacological approach.
Other reviews have focused on Parkinson’s disease (PD) and chronic low back pain in
older adults. Huissoud et al. (2023) conducted a systematic review of studies on nonpharmacological pain management in people with PD, reviewing 18 RCTs. The study found lowto-moderate level of evidence supporting the use of non-pharmacological interventions, with
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interventions that include physical activity being the most effective (Huissoud et al., 2023).
Elsewhere, Fonseca et al. (2023) found low to very low levels of evidence supporting nonpharmacological interventions for chronic low-back pain. The results are similar to Grassini
(2022) regarding inconclusive evidence on non-pharmacological interventions for low-back pain.
These systematic reviews present some of the highest quality evidence in the industry and
contribute to the study by providing an overall review of the intervention’s effectiveness. Taken
together, the reviews indicate that although positive outcomes are reported, the evidence is still
inconclusive on the effectiveness of non-pharmacological interventions.
Physical and Occupational Therapy Interventions
Most non-pharmacological pain management interventions considered in practice have
some form of physical or occupational therapy. For patients recovering from disabling
conditions, it is standard to have rehabilitation that integrates physical and occupational therapy.
Hayden et al. (2021) established that some types of exercise are more effective than others for
chronic low-back pain. In a network meta-analysis, the researchers found that Pilates, McKenzie
therapy, and functional restoration were more effective exercises in reducing chronic low-back
pain than other exercises, but flexibility exercise was more effective in enhancing functional
abilities (Hayden et al., 2021). Although the findings in this study are credible, the issue of
socioeconomic status and engagement with specific types of exercises was not considered as
some of these, such as Pilates, are typically considered by high-income patients.
Moreover, Zhu et al. (2020) compared yoga with non-activity and other physical
interventions in pain and disability improvement in people with chronic low back pain. The
study reports significant improvements in pain and disability with yoga, but it was not superior to
other physical exercises. Unlike Hayden et al. (2021) who reported superior physical exercise,
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Zhu et al. (2020) found no significant difference between yoga and the other approaches.
Overall, both studies report the superiority of exercise and physical therapy to the lack of
physical activity in pain and disability management.
Psychological Conditioning
Industry experts and researchers have also understood pain as a psychological
phenomenon and numerous psychological interventions have been proposed and used. O’Keeffe
et al. (2020) compared cognitive functional therapy (CFT) with group-based exercise and
education in a multi-center RCT. They concluded that CFT was just as effective as multi-group
exercise and education in reducing pain intensity and more effective in reducing disability
(O’Keeffe et al., 2020). Burns et al. (2022) conducted another RCT on cognitive therapy and
mindfulness-based stress reduction impact on chronic pain. Similar to O’Keeffe et al. (2020),
Burns et al. (2022) report that these methods are more effective than treatment as usual in
managing chronic pain. Nevertheless, these studies are limited in generalizability due to the
location of the research. Overall, psychological conditioning approaches such as CFT and
mindfulness-based stress reduction are supported by the evidence to reduce chronic pain.
Neurostimulation
Neurostimulation methods are other popular alternative and complementary pain
management approaches. Zheng et al. (2023) conducted a literature review of long-term RCTs of
neurostimulation interventions. They reported that the majority of the studies found
neurostimulation methods effective as adjunctive rather than primary chronic pain management
interventions (Zheng et al., 2023). Peripheral nerve stimulation was found to be effective in at
least two-thirds of patients with 50% pain relief (Helm et al., 2021). The main limitation of these
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studies is the level of evidence for most of the RCTs. Regardless, this evidence shows that
neurostimulation interventions should be considered in chronic pain management.
Conclusion
Current literature supports non-pharmacological pain management for chronic pain, but
further research is needed. Systematic reviews have identified low-to-moderate level evidence of
the efficacy of non-pharmacological pain management and in some cases inconclusive evidence.
The studies reporting significant effects are single RCTs which cannot be generalized. Even in
those reporting positive outcomes, non-pharmacological pain management is recommended as an
adjunctive therapy rather than an alternative to medications. Further research on the combined
effects of opioids and non-pharmacological interventions should be conducted to determine
efficacy, safety, and effect on opioid usage.
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References
Burns, J. W., Jensen, M. P., Thorn, B., Lillis, T. A., Carmody, J., Newman, A. K., & Keefe, F.
(2022). Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for
the treatment of chronic pain: Randomized controlled trial. Pain, 163(2), 376-389.
https://doi.org/10.1097/j.pain.0000000000002357
Fonseca, L., Pereira Silva, J., Bastos Souza, M., Gabrich Moraes Campos, M., de Oliveira
Mascarenhas, R., de Jesus Silva, H., & Cunha Oliveira, V. (2023). Effectiveness of
pharmacological and non-pharmacological therapy on pain intensity and disability in
older people with chronic nonspecific low back pain: A systematic review with metaanalysis. European Spine Journal, 32(9), 3245-3271. https://doi.org/10.1007/s00586-02307857-4
Grassini, S. (2022). Virtual reality assisted non-pharmacological treatments in chronic pain
management: A systematic review and quantitative meta-analysis. International Journal
of Environmental Research and Public Health, 19(7), 4071.
https://doi.org/10.3390/ijerph19074071
Helm, S., Shirsat, N., Calodney, A., Abd-Elsayed, A., Kloth, D., Soin, A., & Trescot, A. (2021).
Peripheral nerve stimulation for chronic pain: A systematic review of effectiveness and
safety. Pain and Therapy, 10, 985-1002. https://doi.org/10.1007/s40122-021-00306-4
Huissoud, M., Boussac, M., Joineau, K., Harroch, E., Brefel-Courbon, C., & Descamps, E.
(2023). The effectiveness and safety of non-pharmacological intervention for pain
management in Parkinson’s disease: A systematic review. Revue Neurologique, S00353787. https://doi.org/10.1016/j.neurol.2023.04.010
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O’Keeffe, M., O’Sullivan, P., Purtill, H., Bargary, N., & O’Sullivan, K. (2020). Cognitive
functional therapy compared with a group-based exercise and education intervention for
chronic low back pain: A multicentre randomised controlled trial (RCT). British Journal
of Sports Medicine, 54(13), 782-789. https://doi.org/10.1136/bjsports-2019-100780
Zheng, Y., Liu, C. W., Chan, D. X. H., Ong, D. W. K., Ker, J. R. X., Ng, W. H., & Wan, K. R.
(2023). Neurostimulation for chronic pain: A systematic review of high-quality
randomized controlled trials with long-term follow-up. Neuromodulation, 26(7), 12761294. https://doi.org/10.1016/j.neurom.2023.05.003
Zhu, F., Zhang, M., Wang, D., Hong, Q., Zeng, C., & Chen, W. (2020). Yoga compared to nonexercise or physical therapy exercise on pain, disability, and quality of life for patients
with chronic low back pain: A systematic review and meta-analysis of randomized
controlled trials. PloS One, 15(9), e0238544.
https://doi.org/10.1371/journal.pone.0238544
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Pain Management Research Proposal
Name
West Coast University
NURS 540 Research Utilization
Instructor
January 9, 2024
2
Pain Management Research Proposal
The research topic selected for this project is the non-pharmacological management of
chronic pain in adults. The focus of the project is on pain management for patients with chronic
pain such as cancer patients and patients with arthritis. This project seeks to evaluate the
effectiveness of different non-pharmacological pain management approaches for patients with
chronic pain.
Problem Statement
Ideally, people with chronic pain should be able to manage this symptom with minimal
risk as an unwanted consequence. However, for many people with chronic pain, the prescription
of opioids is common due to the high efficacy of opioids in managing severe and long-lasting
pain. An opioid prescription presents a risk of dependence and addiction in patients and even
when prescription guidelines are followed, this risk is still significant (Montgomery, 2022).
Many patients with chronic pain, therefore, face the risk of addiction and dependence on opioids
initially used for pain management. One of the potential solutions to this challenge is prioritizing
effective non-pharmacological pain management.
Research Question
Based on the problem statement, this project seeks to establish the efficacy and safety of
non-pharmacological pain management compared to opioids. The research question is: Among
adults with chronic pain, what is the efficacy of integrating non-pharmacological pain
management with pain medications in reducing pain and dosage of pain medications?
Significance to Nursing
Healthcare professionals have an ethical responsibility to manage patient’s pain and
improve their quality of life. Nurses, especially, are mandated with pain assessment, monitoring,
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and management (Rogers & Kuo, 2020). More than simply administering pain medications as
prescribed, nurses can meet their obligations by exploring evidence-based pain management
alternatives or adjunct therapy. By managing pain in a safer and equally effective method, nurses
promote the safety and well-being of their patients.
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References
Montgomery, L. S. (2022). Pain management with opioids in adults. Journal of Neuroscience
Research, 100(1), 10-18. https://doi.org/10.1002/jnr.24695
Rogers, M. P., & Kuo, P. C. (2020). Pain as the fifth vital sign. Journal of the American College
of Surgeons, 231(5), 601-602. https://doi.org/10.1016/j.jamcollsurg.2020.07.508
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