Pain Management Discussion Nursing Essays
NSG-533-IKC – Advanced Pharmacology
Opioid overuse is a significant problem in the United States and abroad. According to Covvey 2015, hydrocodone is one of the most prescribed and widely abused schedule II drugs, contributing to the opioid epidemic. Prolonged use of opioid medication is also associated with increased mortality rate due to overdose. Chronic pain can play a role in patient dependency on narcotic medications; frequent evaluation of pain and patient medication management should be considered with prescribing various scheduled drugs. In the case study, it is evident that the patient has developed a dependency on the medication, or her pain is not being appropriately managed. Upon assessment, the current medication regimen should be changed to an extended-release drug and maybe incorporate a non-narcotic along with non-pharmacological methods.The determined conversion reduced by 25% for hydrocodone APAP 10/325 to morphine ER 7.5 mg daily every 4-6 hours. According to Seago 2016, research conducted identified no change in patient behavior of users in the prescription drug when changed to morphine with a federal recommendation to change, reduction in Norco (Hydrocodone) 10/325, and no statistically significant change in morphine sulfate. Alternative medicine may offer relief with combination therapy; however, this method of treatment if often frowned upon due to lack of research. The use of non-pharmacologic modalities has been questioned by medical practitioners because of the perceived lack of prospective, randomized, double-blind sham-controlled studies supporting their use in clinical practice (White et al., 2017).
A few alternative therapies that may be used along with medication for this patient may include Electroanalgesia is a form of neuromodulation therapy, percutaneous electrical nerve stimulation (PENS), or transcutaneous electrical nerve stimulation (TENS). In addition to changing the opioid, it may also be beneficial to prescribe a non-opioid break-through medication to ensure the patient does not have any acute pain due to a change of medication Pain Management Discussion Nursing Essays.
Migraine headaches are characterized by the attacks of unilateral, throbbing head pain, with sensitivity to movement, visual, auditory, and other afferents inputs (Goadsby et al., 2017). In this case, CM is also experiencing difficulty sleeping and is mildly anxious; these symptoms could be a result of her post migraine symptoms that can cause fatigue and anxiousness days to months post the migraine. Her medication options include drug therapy that is not contraindicated with inhaler use. Non-pharmacologic treatment for migraine management, which could consist of avoiding triggers such as audio, visual, movements, and stress. CM could also darken the room, apply ice to the neck area, drink a caffeinated beverage, and improve sleep. She should also maintain a diary to keep track of the frequency and triggers association with her headaches. Prophylaxis migraine treatment may be an option; however, per the literature, the practice is more familiar with chronic migraine patients. Prophylactic migraine treatment should be considered if more than three migraine headaches per month or eight headache days in one month, in severe debilitating headaches despite appropriate acute treatment, intolerant, or have contraindications to acute therapy (Kumar & Kadian, 2020).
Reference
Covvey J. R. (2015). Recent developments toward the safer use of opioids, with a focus on hydrocodone. Research in social & administrative pharmacy : RSAP, 11(6), 901–908. https://doi.org/10.1016/j.sapharm.2015.02.001
Kumar, A. & Kadian, R. (2020 Aug 15). Migraine prophylaxis. StatPearls. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK507873/
Seago, S., Hayek, A., Pruszynski, J., & Newman, M. G. (2016). Change in prescription habits after federal rescheduling of hydrocodone combination products. Proceedings (Baylor University. Medical Center), 29(3), 268–270. https://doi.org/10.1080/08998280.2016.11929431
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View profile card for Kelly Miskovsky
Last post Oct 15, 2020 9:39 AM by Kelly Miskovsky
Module V: Pain Management Discussion
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There are hundreds of opioid conversion calculators available online, though they are not all of good quality. I would like to direct you to one of the opioid conversion calculators that I find to be most useful and evidence based. Locate http://opioidcalculator.practicalpainmanagement.com/ and evaluate the following case using the calculator as necessary. Discuss your approach to the overall case and results of your calculation.
A 79 year old white male is taking hydrocodone/APAP 10/325 for lower back pain (pt diagnosed with degenerative disc disease several months ago). The physician had written a prescription for Vicodin® 10/325 i-ii Q4-6h prn pain with a quantity of 120. Her expectation was that this would last the patient for one month. The patient is now requesting refills about every 10-14 days. He states he has been taking 2 tabs Q4h (12 tablets per day) because “the pain is so bad I just can’t stand it!”.
What is the problem with the way the patient is taking this medication versus the way it was prescribed
Based on your assessment, it is determined this patient should be converted to extended release morphine for better, more consistent pain control. Perform this conversion and provide an appropriate recommendation (drug, dose, frequency).
Migraine is a major neurological disease that affects more than 36 million men, women and children in the United States. There is no cure for migraine. Most current treatments aim to reduce headache frequency and stop individual headaches when they occur. Let’s look at a case example:
CM is 20 years old female with severe, prolonged 2 to 3 day migraines twice per month. She has difficulty sleeping and is mildly anxious. She occasionally utilizes an inhaler for asthma.
Provide an evaluation of CM’s condition including non-pharmacological interventions and treatment options
Is Cm a candidate for prophylactic therapy, and if so, what option would be best suited to her?
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section Pain Management Discussion Nursing Essays.
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Module V
Pawn Johnson-Hunter posted Oct 1, 2020 1:59 AM
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Shante Hunt posted Sep 30, 2020 7:10 PM
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The first patient is a 79 year old male who has been prescribed hydrocodone/APAP 10/325 for lower back pain. The directions on his prescription is to take one to two tablets every four to six hours as needed for pain, and the patient reports that he is taking two tablets every four hours, or twelve pills per day for severe pain. Based on this information, the patient is taking a total daily dose of 120 mg of hydrocodone. When converting hydrocodone to extended release morphine, or MS Contin using the standard MME dosage conversion (cdc.gov), the patient should receive 120 mg of equianalgesic however to decrease the risk of sedation I have chosen to lower the dose by 25% for a total daily dose of MS Contin 90 mg daily divided in 3 doses. Decreasing the dose by this amount is done to prevent overdose and to allow for incomplete cross tolerance that can occur when switching from one opioid to another (cdc.gov, 2018). Another motivating factor to discontinue the use of Vicodin is that this patient is also consuming 3,900 mg of acetaminophen daily and while that is just below the daily allowance of 4,000 mg, caution should be exercised in this patient due to his age and potential for decreased renal function. This patient has been taking this medication on a scheduled basis rather than as needed so it is clear that his pain is not well managed using Vicodin. Mehalick et al (2016) demonstrated that the use of opioid pain medication versus the use of combination non-opioid/opioid medications for treatment of low back pain did not demonstrate a significant difference in reports of pain levels, either increase or decrease. Therefore, it is clinically beneficial to eliminate acetaminophen in this case as he may increase the frequency of administration on his own.
CM is a 20 year old female who reports symptoms associated with acute migraine headaches that are severe in nature. Initial treatment of mild to moderate migraines should begin with NSAIDs, however since CM reports her symptoms as severe she meets criteria for a migraine specific medication such as Sumatriptan 25 mg by mouth, with instructions to repeat the dose if no effect in two hours (MacGregor, 2017). This medication can also be given intranasally if nausea presents and CM cannot tolerate anything by mouth, but it is also more rapidly absorbed and provides faster relief of symptoms. Non-pharmacological treatment of migraines should include a comprehensive review of CM’s diet and suggested dietary changes to avoid caffeine, artificial sweeteners and MSG (MacGregor, 2017). A full assessment of triggers and timing can indicate whether the attacks are as a result of hormonal changes in the menstrual cycle and whether or not an aura exists. Since CM’s attacks do not follow a specific pattern, nor does she have fifteen or more attacks per month, I would not recommend prophylactic treatment for her, rather I would follow her closely to determine if increased doses of acute medications are warranted.
Centers for Disease Control and Prevention. (2018). CDC guidelines for prescribing opioids for chronic pain. https://www.cdc.gov/drugoverdose/prescribing/guideline.html
MacGregor, E.A. (2017). In the clinic. Migraine. Annals of Internal Medicine, 159(9), 1-16. Doi: 10.7326/AITC201704040
Mehalick, M., McPherson, S., Schmaling, K., Blume, A., & Magnan, R. (2016). Pharmacological management of chronic low back pain: A clinical assessment. Journal of Pain Management, 9(1), 39-48. http://web.b.ebscohost.com.wilkes.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=9&sid=d04dba72-9552-49ef-b9b5-ca650bc0e737%40pdc-v-sessmgr03
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Last post Oct 15, 2020 9:35 AM by Kelly Miskovsky
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Anna McMullen posted Sep 28, 2020 4:41 PM
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View profile card for Pawn Johnson-Hunter
Last post Oct 4, 2020 9:18 PM by Pawn Johnson-Hunter
Module V Pain Management
Gisselle Mustiga posted Oct 1, 2020 12:52 AM
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