Theses and Dissertations at Montana State University (MSU)
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Item Chronic Pain Management, Opioid Tapering Guideline(Montana State University - Bozeman, College of Nursing, 2024-05) Wheeler, Madisen M.Chronic pain is an ongoing issue facing many Americans and individuals globally. Patients have historically been prescribed opiates and narcotics as a common care plan to help manage the chronic pain that they are experiencing. Recent guideline changes to the CDC’s recommendation on opioid prescribing, has had a monumental impact on chronic pain and chronic care management patients. Many patients in a rural access facility in the United States, are discontinued from their opioid pain medications, with no taper, leading to negative and poor health outcomes not only for the patient, but for the community.Item Improving standardization in care of patients with chronic pain: a focus on harm reduction(Montana State University - Bozeman, College of Nursing, 2023) Locke, Erin Michelle; Chairperson, Graduate Committee: Amanda H. LucasBackground: The opioid crisis remains a major public health issue in the US, with escalating opioid-related deaths annually. Long-term opioid therapy (LTOT) for chronic pain carries a high risk of adverse events, including opioid use disorder (OUD), overdose, and mortality. Standardizing harm-reduction practices, like risk assessment, naloxone access, and early OUD identification, can mitigate risks and enhance patient outcomes. Local Problem: Primary care patients with chronic pain on LTOT need harm reduction to improve patient safety and quality of life. Methods: A six-week plan-do-study-act cycle was employed. Descriptive statistics assessed intervention feasibility. Intervention: The Opioid Risk Tool (ORT) evaluated individual risk for developing an OUD. Patients who screened positively (score > or = 3) on the ORT received provider evaluation, using DSM-5 criteria, for OUD diagnosis. If diagnosed, patients received education about OUD and treatment options with buprenorphine. Naloxone prescriptions were offered by nurses to all patients with chronic pain. Results: All 17 patients with chronic pain completed the ORT, with 9 (53%) identified as high-risk, and 2 (11.8%) diagnosed with OUD. No referrals were made for buprenorphine therapy. Additionally, 13 (76%) patients were offered naloxone prescriptions, and 100% of offered prescriptions were filled. Conclusion: Implementing harm-reduction practices for patients on LTOT for chronic pain is feasible. Further projects will assess the long-term sustainability and impact on patient outcomes.Item Opioid guideline adherence for Tramadol in those with chronic nonmalignant pain(Montana State University - Bozeman, College of Nursing, 2020) Horine, Harold James, III; Chairperson, Graduate Committee: Susan LuparellPain is a very common problem affecting up to one-third of the entire population of the United States at any given time and for those with pain, 1 in 3 people have chronic nonmalignant pain lasting longer than 3 months (Centers for Disease Control and Prevention [CDC], 2016b). A majority of those with pain are seen in a primary care setting initially, and sometimes on an on-going basis (Gatchel, 2004; National Institute of Health [NIH], 2010). Ensuring comfort by addressing pain levels in patients is a primary, ethical nursing duty. Historically, one common modality used to treat pain is the use of opioids. However, the literature indicates that healthcare practitioners at all levels receive little education on how to manage chronic pain utilizing prescription opioids in the primary care setting. A lack of education on prescribing opioids has helped create an epidemic of dependence and overdoses on opioids. Additionally, the opioid crisis has continued despite many attempts at various levels, including executive and legislative bills, to try and stop opioid abuse and overdose. Although originally touted as a safe alternative to opioids and slightly stronger than over-the-counter analgesics, tramadol is an opioid with regulation by the Drug Enforcement Agency and Food and Drug Administration that, upon review, does not appear to be in line with the gold standards for prescribing opioids, such as the 2016 Center for Disease Control and Prevention guidelines or the 2018 Montana Utilization and Treatment Guidelines, for nonmalignant chronic pain management with opioids. The purpose of this project was to assess provider knowledge related to tramadol and providers' adherence to the present opioid guidelines when prescribing tramadol in a small, southwestern Montana community.Item The progression from acute to chronic low back pain: a systematic review of risk factors and practice recommendations(Montana State University - Bozeman, College of Nursing, 2018) Sheehan, Willow Anne; Chairperson, Graduate Committee: Jennifer SofieAcute low back pain (LBP) is common and can lead to chronic LBP. Chronic LBP carries the risk of significant financial burden and reduced quality of life. If low back pain persists beyond six weeks, the likelihood of recovery is limited. Therefore, it would be beneficial to identify those acute LBP patients most at risk of progressing to chronic LBP early in the disease process. This project seeks to identify acute LBP risk factors (RFs) that are most predictive of chronic LBP in primary care populations. A systematic review of literature was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Article review resulted in the inclusion of 13 studies with 3,641 subjects, evaluating 104 RFs. Data extraction and analysis based on the review protocol resulted in clinical practice and future research recommendations. Coping by catastrophizing and the patient's perspective of risk of chronicity are the most well-supported RFs identified and can be safely assessed in clinical practice for the purpose of recognizing those acute LBP patients most at risk of chronicity and in need of early intervention. An additional 82 RFs are discussed for their value in future research and potential implications for future clinical practice.Item Best practices in pain management in primary care : a teaching project(Montana State University - Bozeman, College of Nursing, 2015) Griffin, Annette Marie; Chairperson, Graduate Committee: Linda TormaPain is common and affects approximately 9 in 10 Americans and is the most common reason people seek health care. One of the first stops to receiving care is in a primary-care setting. Considering the high prevalence of patients with pain, it's important to have knowledge of pain and the management of pain conditions, as well as the psychosocial factors involved with a chronic-pain condition. Research has also shown that many healthcare professionals receive little education in their training programs. The purpose of this project was to improve chronic-pain management in a community health care center (CHCC). The specific aim was to increase knowledge about best practices in pain management by 10% in CHCC staff. A comprehensive assessment of a CHCC was conducted to assess the quality of pain management in the CHCC. Education was developed to address the knowledge needs about pain management that were revealed in the assessment. A review of the literature was conducted after the assessment to identify best practices in pain management. In-services that included information about current best practice guidelines for chronic-pain management were provided to the staff. A pre-test was administered prior to each presentation to assess current knowledge, and a post-test immediately followed each presentation to evaluate the effectiveness of the presentation. Qualitative feedback about the presentation was also elicited on the post test. The assessment revealed that 8.5% of the patient visits were for a diagnosis of chronic pain, and the staff requested more information about best practices in pain management. The pre/post test results showed that the specific aim was achieved. Qualitative feedback indicated that the staff appreciated the in-service and wanted more information on a regular basis. The nursing staff also indicated that they would like to play a larger role in helping to manage this population in the clinic. Given the growing number of persons living with chronic pain, continuing education about pain management best practices is needed by staff working in community health care centers to ensure adequate assessment and management of chronic pain. Clinical implications and recommendations for future research are also discussed in this paper.Item Patient perceptions of treatment options for chronic pain(Montana State University - Bozeman, College of Nursing, 2008) Benzschawel, Valerie Chyle; Chairperson, Graduate Committee: Elizabeth G. NicholsChronic pain and pain management are frequently discussed and debated topics in American medicine today. The patients' understanding of treatment options for management of chronic pain is a less frequently discussed topic. The purpose of this study is to explore patient perceptions of chronic pain treatment options. The framework for guiding this study was Neuman's Systems Model (1995) based on the concepts of stress, client stability, and intervention. A review of the literature was completed that revealed very little information on the topic and therefore further research regarding patient perceptions of treatment options for chronic pain was warranted. Nine patients participated in interviews and shared their experiences with treatment options and contexts or situations that influenced or affected those experiences of treatment options. Participants described their experience with chronic pain to include options available to them; the effectiveness of the methods tried; lifestyle changes associated with their pain; feelings of hopelessness for the future relative to pain resolution as well as available options; the effects of listening and understanding; and depression.Item Assessing barriers to opioid pharmacotherapy for chronic pain in Montana(Montana State University - Bozeman, College of Nursing, 2011) Sewell, Saundra Knowles; Chairperson, Graduate Committee: Wade G. Hill.Chronic pain affects an estimated 76.2 million people in the United States yet health care providers face significant barriers to provision of safe and effective chronic pain management. Research has identified pharmacotherapy as an important component of a multi-disciplinary care plan for chronic pain management, but complexities associated with pain pharmacotherapy are also a source of barriers to chronic pain management. Little is known about barriers to provision of chronic pain management that may be unique to rural settings such as Montana. The primary goal of this research effort was to develop a questionnaire to assess barriers faced by health care providers to the use of pharmacotherapy for chronic pain in Montana. Following a comprehensive literature review of barriers to chronic pain management, a draft questionnaire containing 24 questions was developed and submitted to an expert panel of providers with prescriptive authority in Montana. A tailored Delphi technique was used to gather input about the proposed questionnaire from the expert panel. The results confirmed the importance of assessing barriers in Montana and the presence of significant barriers to opioid pharmacotherapy for chronic pain. The responses provided key information for revision of the questionnaire, improving the questionnaire clarity and relevance to Montana. This project represents an essential first step in the development of an assessment tool for use in Montana to identifying the existence and relative impact of barriers to chronic pain management. Understanding the relative influence and impact of these barriers will help mitigate barriers that impede adequate chronic pain management and help identify support needs of health care providers in chronic pain management.