Chronic Pain case study peer review
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Post your response to the case study here by answering the following questions:

Are the clinical practice guidelines used in this case study appropriate? Why or why not?

Do you agree with the initial treatment plan? Why or why not. Use clinical practice guidelines to support your answer.

Provide evidenced-based addition or provide constructive feedback to the case study.
please use professional articles cite in apa 7 th edition

Nursing Pharmacology: Chronic Pain Case Study Peer Review Response

Chronic pain is a major problem in the United States. Most of this pain is usually caused by conditions of musculoskeletal etiology but also or neurologic origin. When nerve roots are compressed as occurs due to prolapse of one or more of the intervertebral discs, the pain is usually unbearable and barely responsive to traditional pain relief methods. This is why pain management in the cases of chronic pain must follow laid down clinical guidelines that are informed by evidence from research on efficacy (AAPM, 2022; Melnyk & Fineout-Overholt, 2019). The purpose of this paper is to respond to a case study on the conformity or otherwise of the measures taken in the case to manage chronic pain of neurologic origin.  Nursing Pharmacology Chronic Pain Case Study

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Appropriateness of the Clinical Practice Guidelines

In the case study, there are some elements that are appropriate as per the clinical practice guidelines. However, there are also some other elements in the management that are not in conformity to the clinical practice guidelines. To begin with, the decision to perform a laminectomy to correct the intervertebral disc prolapse was the correct one as indicated by the American Academy of Pain Medicine (AAPM, 2022) clinical guidelines. The other correct decision to manage the chronic pain in this case that is appropriate is the prescription of Percodan which has an opioid component in it. It is actually a combination of an opioid and a non-opioid analgesic and this is correct given the nature of the pain in patients who have undergone laminectomy. Percodan has oxycodone and acetyl salicylic acid (aspirin) in it (325/4.8) for pain relief (Rosenthal & Burchum, 2018). According to the clinical practice guidelines, the use of opioid analgesics in chronic pain of neurologic and musculoskeletal origin such as that in prolapsed discs is recommended (AAPM, 2022). The 78 year-old lady was therefore properly managed to this extent.

However, this is an elderly patient of 78 years old and therefore her tolerance of medications is low. The fact that she has been put on nine different pharmacologic agents at the same time does not follow the clinical practice guidelines at all. This is because the chances of the medications potentiating each other of cancelling the effects of each other are very high. The pharmacokinetics in elderly persons (ADMI) is also compromised. This means that the levels of active metabolites of these medications can accumulate to dangerous amounts in the blood. This may have disastrous consequences. The use of polypharmacy in this case therefore goes against the clinical practice guidelines with regard to the elderly (Kim & Parish, 2017). They are a vulnerable group that must be protected against polypharmacy.

Another reason why the management in this case goes against the clinical practice guidelines is that the patient has been proven to have reduced kidney function (reduced estimated glomerular filtration rate or eGFR). For this reason, she should have never been put on all those medications since a good number of them are excreted in the urine (Rosenthal & Burchum, 2018). Lastly but not least, the use of alternative modes of pain relief from complementary and alternative medicine (CAM) is acceptable according to clinical practice guidelines. It is clear that in this case these have been presented as options in case the patient will not respond to the current treatment. A good example is acupuncture.

Conclusion

The management of chronic pain is not easy. This is because the ain is usually recalcitrant and resistant to many pain medications. The clinical practice guidelines recommend the use of particular opioid analgesics for moderate to severe chronic pain. In the presented case, most of the actions taken conform to the clinical guidelines but a number of them also do not. For example, the elderly patient should not have been put on so many drugs as this is counterproductive.

References

American Academy of Pain Medicine [AAPM] (2022). Clinical guidelines. https://painmed.org/clinical-guidelines/

Kim, J., & Parish, A.L. (2017). Polypharmacy and medication management in older adults. Nursing Clinics of North America, 52(3), 457–468. https://doi.org/10.1016/j.cnur.2017.04.007

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.

Nursing Pharmacology Chronic Pain Case Study