Pharmacological and Non-Pharmacological Interventions for Pain Management in Rheumatoid Arthritis Patients
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Added on 2023/04/25
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This article discusses the use of pharmacological and non-pharmacological interventions for pain management in rheumatoid arthritis patients. It includes a PICO question, research problem, hypothesis, and references.
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Running head: PICO QUESTION PICO Question Name of the Student Name of the University Author Note
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1 PICO QUESTION Patient/Problem Adult population with rheumatoid arthritis for <= 5 years and age bar in between 30 to 60 years. Intervention Medication (DMARDS) and exercise Exercise: Planning for the physical exercise for 6 months of individualized aerobic exercise training along with resistance high intensity exercise training for three times per week. This will be followed by Upper Extremity Exercise Training. Physical exercise training will be given by a trained physiotherapist and physical training expert under active supervision of the nursing professional. Medication management will be controlled by the nurse as per the dosage and administration route recommended by doctor. Comparison Medication (DMARDS: Disease Modifying Anti-rheumatoid Drugs) only Outcome More satisfactory pain relief: The pain-relief will be accessed on basis of the pain assessment by pain-score. The recovery from pain will be executed through improvement in the extremity disability, improvement in the handgrip strength and increase in the self- efficacy. The pain relief is also attained by improvement in the cardio-vascular functions like promoting cardio-respiratory fitness along in increase in the flexibility of the wrists and other joint parts
2 PICO QUESTION Write out your research problem Rheumatoid arthritis is an auto-immune disease that causes chronic inflammation in joints. Unlike wear-and-tear damage of the osteo-arthritis, rheumatoid arthritis affects the inner lining of the joints resulting in painful swelling that eventually leads to the development of bone deformity and erosion of bones. The main symptoms of the rheumatoid arthritis (RA) is swelling and pain in joints that hamper the quality of life of the adults along with restriction in conducting daily living activities (Okada et al., 2014). The study conducted by Van Dartel et al. (2013) further highlighted that pain among the patients with RA is associated with fatigue. Increase level of fatigue associated with pain cause the daily life experience debilitating, restricting day-to-day functioning. Increase in pain, increases the severity if fatigue resulting in mood swings, behavior and beliefs. In relation to the intervention, Van Dartel et al. (2013) highlighted that decrease in pain leads to decrease in the severity of fatigue and thereby helping to execute daily living activities. Lee et al. (2013) are of the opinion that pain among the patients with RA hampers the quality of sleep at night. The peripheral inflammation occurring in pain is modulated by the central nervous system. Conditioned modulation of pain by the central nervous system hampers the quality of life of the adults with RA. Andersson, Svensson and Bergman (2013) further stated that chronic wide-spread pain among the patients with rheumatoid arthritis cause swollen joint, poor cardiac activity. This restricted movement create barrier towards successful accomplishments of daily living activities and thereby hampering the overall quality of life. In order to manage pain, the use of the Disease Modifying Anti-rheumatoid Drugs (DMARD) is recommended by the healthcare professionals. One of the well known DMARD include Tubastatin. Tubastatin is a selective histone deacetylase 6 inhibitor, which is found to display anti-inflammatory and anti-rheumatic effects. Tubastatin mainly executes it function by inhibiting cytokines TNF-alpha and IL-6 under the action of the THP-1 marcophages
3 PICO QUESTION (Vishwakarma et al., 2013). Okada et al. (2014) are of the opinion that inflammation associated with rheumatoid arthritis can cause damage to other parts of the body. Though, improved treatment options are there but prolong use of the pain management medication results in unwanted side-effects. According to Watanabe et al. (2013) there are several risk factors behind the implementation of the DMARD for pain management in RA. Prolong use of the DMARD results in the generation of small intestinal damage along with increasing the vulnerability of developing complications related to stomach and digestion. Thus the main problem statement, prolong use of the DMARD for the effective management of pain among the adults with RA is not a plausible options as it might increase the chances of developing additional side-effects. Manning et al. (2014) argued that non- pharmacological interventions for the effective management of pain can be employed for managing pain among the patients with RA with no possible side-effects. However, unlike medicines, the non-pharmacological interventions like physical exercise are unable to extract quick results or pain relief. Write out your research hypothesis The implementation of the medication management (pharmacological intervention) along with practice of the physical exercise (non-pharmacological intervention) will help to bring effective recovery from pain in comparison to the individuals who will receive only medication management of pain. The research hypothesis is mainly driven by the systematic review conducted by Giné-Garriga et al. (2014). The systematic review conducted by Giné- Garriga et al. (2014) over the randomized control trials highlighted that exercise has certain benefits over the frail adults suffering from joint pain. Regular practice of the mild-to- moderate physical exercise helps to improve the gait function of the adults suffering from joint pain. The improvement of the gait function helps to reduce the pain and thereby
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4 PICO QUESTION improving the quality of life of the older adults along with decrease in the chances of accidental falls. Ambrose and Golightly (2015) are of the opinion that physical exercise is an effective non-pharmacological intervention for the effective management of the chronic pain. Physical exercise helps to improve general health, reducing disease risk and severity of pain. Thus the main research hypothesis is effective implementation of the pharmacological and non-pharmacological interventions among the adults suffering from RA for 5 years of more will be helpful in reducing the severity of pain. The decrease in the level of pain will be associated with improvement in flexibility of the joints, cardiac functions, physical fitness and gait functions and thereby helping to improve the quality of life of the adults. Moreover, the use of physical exercise along with the medication management of pain will extract better results in comparison to the individuals who will be given only medication management. The use of non-pharmacological interventions along with the medication management will help to reduce the dosage requirement of DMARDS for pain management of RA and thereby helping to reduce the side-effects of long-term use of DMARDS. The hypothesis also include effective use of the multi-disciplinary team like nursing professionals, physiotherapists, physical training experts and doctors for improving the quality of care of the adults suffering from RA.
5 PICO QUESTION References Ambrose, K. R., & Golightly, Y. M. (2015). Physical exercise as non-pharmacological treatmentofchronicpain:whyandwhen.Bestpractice&researchClinical rheumatology,29(1), 120-130. Andersson, M. L., Svensson, B., & Bergman, S. (2013). Chronic widespread pain in patients with rheumatoid arthritis and the relation between pain and disease activity measures over the first 5 years.The Journal of rheumatology,40(12), 1977-1985. Giné-Garriga, M., Roqué-Fíguls, M., Coll-Planas, L., Sitja-Rabert, M., & Salvà, A. (2014). Physicalexerciseinterventionsforimprovingperformance-basedmeasuresof physical function in community-dwelling, frail older adults: a systematic review and meta-analysis.Archives of physical medicine and rehabilitation,95(4), 753-769. Lee, Y. C., Lu, B., Edwards, R. R., Wasan, A. D., Nassikas, N. J., Clauw, D. J., ... & Karlson, E. W. (2013). The role of sleep problems in central pain processing in rheumatoid arthritis.Arthritis & Rheumatism,65(1), 59-68. Manning, V. L., Hurley, M. V., Scott, D. L., Coker, B., Choy, E., & Bearne, L. M. (2014). Education, self‐management, and upper extremity exercise training in people with rheumatoid arthritis: A randomized controlled trial.Arthritis care & research,66(2), 217-227. Okada, Y., Wu, D., Trynka, G., Raj, T., Terao, C., Ikari, K., ... & Graham, R. R. (2014). Geneticsofrheumatoidarthritiscontributestobiologyanddrug discovery.Nature,506(7488), 376.
6 PICO QUESTION Van Dartel, S. A. A., Repping‐Wuts, J. W. J., Van Hoogmoed, D., Bleijenberg, G., Van Riel, P. L. C. M., & Fransen, J. (2013). Association between fatigue and pain in rheumatoid arthritis: does pain precede fatigue or does fatigue precede pain?.Arthritis care & research,65(6), 862-869. Vishwakarma, S., Iyer, L. R., Muley, M., Singh, P. K., Shastry, A., Saxena, A., ... & Rathinasamy, S. (2013). Tubastatin, a selective histone deacetylase 6 inhibitor shows anti-inflammatoryandanti-rheumaticeffects.International immunopharmacology,16(1), 72-78. Watanabe, T., Tanigawa, T., Nadatani, Y., Nagami, Y., Sugimori, S., Okazaki, H., ... & Koike, T. (2013). Risk factors for severe nonsteroidal anti-inflammatory drug-induced small intestinal damage.Digestive and Liver Disease,45(5), 390-395.