NSB203 - Evaluating Opioid Alternatives for Chronic Pain Safety

This report presents a critical analysis of the debate surrounding the use of opioids for chronic pain management and its impact on patient safety. It compares and contrasts qualitative and quantitative research approaches used to investigate this clinical issue, highlighting the importance of both methodologies in understanding the complexities of opioid use. The report examines randomized control trials and quantitative analyses that assess the effectiveness and safety of long-term opioid treatment, while also considering qualitative studies that explore patient perceptions and satisfaction levels. Furthermore, it reflects on how alternative arguments against opioid use have influenced the author's perspective, emphasizing the need for increased awareness of opioid-related risks and adherence to prescribed guidelines. The analysis underscores the relevance of this knowledge to future nursing practice, particularly in ensuring patient safety during medication administration. Desklib provides access to this and other solved assignments.

Running head: EVIDENCE BASED NURSING RESERACH
EVIDENCE BASED NURSING RESERACH
Name of the Student
Name of the university
Author’s note

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Written critical analysis
Introduction to the topic
This report is has been prepared in context of a debate on "avoiding the use of the opioids
for chronic pain would improve patient safety". Each of the participants were allowed to speak
for or against the topic. On the other hand, the second part of the assignment consists of a critical
analysis of the different research approaches used in answering the particular clinical issue. The
main aim of the second part of the assignment is to critically analyze both the qualitative and the
quantitative approaches used in this research. This paper would finally inform how the
alternative arguments have influenced my thinking process.
Compare and contrast quantitative and qualitative approaches
Research can be considered as an academic activity that is mainly done in order to
answer an issue. Research refers to defining and redefining of the questions, formulation of the
suggested solution or hypothesis, collection, organization and evaluation of the data and finally
reaching a conclusion based upon the findings of the research (Allwood, 2012). Research forms
the base of medical science and has been classified in to several types based on the better
understanding of the different concepts. One of the most important types of researches are
qualitative or quantitative research methods. It is mostly applied to the incidents that has to be
expressed quantitatively. The qualitative research on the other hand is applicable to phenomenon
that is determined by its quality (Allwood, 2012). For example motivation research is an
essential qualitative research that is based on in depth interviews. This kind of researches mainly

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aims to understand the underlying motives or the designs using face to face interviews. Some of
the other methods of such researches are word association test , sentence completion tests and
story completion test. Qualitative researches are of special importance in behavioral science,
understanding the underlying human behaviors (Yilmaz, 2013). Qualitative research method is a
process of enquiry that helps to develop an understanding of human and social sciences. It is
holistic in nature unlike the quantitative research and is subjective; the perception of the
participants might differ from the thought process of the researcher or the actual truth. The
qualitative research type is exploratory and inductive unlike the qualitative researches where the
research type is conclusive and the reasoning type is deductive. The sampling method used in a
qualitative research is purposive, whereas in case of quantitative method random sampling is
used (Choy, 2014). Most of the data obtained in quantitative research is measurable. Since
qualitative data analysis is mainly done on the basis of the interviews, the data is collected
verbally. The methods used in qualitative studies are non-structured techniques, in depth
interviews and group discussions, whereas quantitative studies use surveys, questionnaires and
observations (Choy, 2014).
The results obtained in a qualitative research helps to develop an initial understanding.
Whereas the results of a quantitative research are straightforward and recommends a final course
of action.
Importance of qualitative and quantitative researches surrounding this practice issue
Some of the importance of the quantitative research is that the statistics can be used to
generalize the findings and reducing and restructuring complex problems to a limited number of
variables. Since the topic is based on the use of opioids in treating chronic pain. Randomized

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control trials have been found quantifying the reduction of the chronic pain in adults by using
different numeric scales and then analyzing the findings by using statistical methods (Baumblatt
et al., 2014).
A randomized control trial by Chaparro et al. (2013), have been conducted in order to
compare the use of opioids compared to placebo or other options in the treatment of the lower
back pain. Male and female participants of 18 years of age who have had persistent lower back
pain for at least 12 weeks were taken in to consideration. Primary outcome measures like pain
ratings, verbal scale ratings, Quebec Back Pain Disability Scale (QBPDS) were taken. Opioids
like tramadol has been compared to placebo. The opioids were compared to other analgesics and
other drugs The reports on the pain and function outcomes has been measured using standardized
mean difference using the risk ratios with a confidence interval of about 95 % . Hence the
qualitative research has been successful in comparing the effectiveness of opioids with other
drugs. Opioids have long been used to treat chronic nonmalignant pain. A quantitative analysis
was done to test the hypothesis that long term opioid treatment for the management of chronic
pain that is nonmalignant is effective and the primary problem associated with the safety of such
a treatment is that the risk assessment of opioid addiction has been always neglected. As per the
findings the safety of the long term treatment of opioid, has not been assessed properly (Kissin,
2013).
Another article by Wilder et al. (2016), have again focused on the risk factors for the
opioid overdose risk among the veterans prescribed with chronic opioids for pain or addiction.
90 veterans suffering from chronic pain and under pain medications were made to complete a
questionnaire for assessing the risk factors, knowledge and self-estimate for the risk of overdose.
Instruments like opioid Overdose Knowledge Scale (OOSK), was the instruments t used. The

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statistical tests conducted at 5 % type 1 error rate with Bonferroni correction for multiple
comparisons were sed. The Chi square test and Wilcoxon rank-sum test was performed to
compare the baseline demographics and medications used in two clinics. All these instruments
and the tests used in this quantitative study can be useful in identifying the fact that Veterans
receiving prescribed opioids for chronic pain might be at risk of opioid overdose risks and do not
have any awareness about the risks. Another study has been done to evaluate the standard
sedation assessment for the administration of the opioid. In this study quantitative scales such as
opioid induced seduction scales has been used (Kobelt, Burke & Renker, 2014). A study by Bot
et al. (2014), have aimed at proving a satisfaction level in patients after being treated with opioid
medications following a hip surgery. Ninety seven patients were being interviewed and a
numeric pain rating scale has been used to understand the pain intensity. Interview is an
important aspect of qualitative research used to determine the perception of people about a
particular interventions. Initial bivariate and multivariate analysis was used for the identification
of the factors associated with pain intensity.
How the alternative argument have affected my opinion?
Although I have always learnt that opioids were safe to use on treating chronic pain such
as back pain or chronic nonmalignant pain. But truly there are lack of high quality of evidences
about long term opioid treatment of chronic nonmalignant pain. Most of the studies conducted
were without any proper control group. Hence, I could not nullify some of the evidences put
forward by the opponents speaking against the topic. While investigating about the opioid
medication, I have come across a study by Lee et al. (2015) that have proved that post-operative
respiratory depression can be significant cause of death among the patients, hence the risk factor
related to opioid administration cannot be totally disregarded. Another case control analysis by

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Zedler et al. (2014), have indicated towards prescribed opioid use and the deaths related to the
serious toxicity. Substantial risks for opioid related toxicity and overdose have been found to be
associated even at low dose opioids. Although I have come across many evidences in support of
opioid medications but the alternative views has made me more alert about opioid
administration.
Relevance to my future nursing career
In order to participate in this debate I had to go through a large number of literary sources
and valid government websites in order to find out the information about the mode of action of
the opioid and their effectiveness in treating chronic pain. This have enhanced by knowledge
about the different types of opioids used in treating different types of chronic pain. The
information obtained from the opponent members have enhanced my knowledge about the
different side effects of opioid medications.
I have understood that when the opioids are prescribed, they come with several risks that
are important to understand. One of the risks that I have identified, is the opioid overdose that
can be lethal for the patients. This has made me more alert about the dosages of the medications.
It is not that I have accepted the facts put forward by the opponents blindly, but have verified
them with original references. Hence it is critical that nurses understand the signs and the
symptoms of an opioid overdose things to be done if such overdose occurs. I have also learned
about opioid tolerance and opioid dependence, that is the body will need higher doses of opioid
than before for achieving the safe amount of relief from pain. Furthermore I am well aware of
opioid addiction that can occur in the patients taking opioid and can even lead to liver and brain
damage. All these knowledge have made me aware of the prescribed guidelines for using opioid
medications that would help me in ensuring patient safety during medication administration.

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References
Allwood, C. M. (2012). The distinction between qualitative and quantitative research methods is
problematic. Quality & Quantity, 46(5), 1417-1429.
Baumblatt, J. A. G., Wiedeman, C., Dunn, J. R., Schaffner, W., Paulozzi, L. J., & Jones, T. F.
(2014). High-risk use by patients prescribed opioids for pain and its role in overdose
deaths. JAMA internal medicine, 174(5), 796-801.
Bot, A. G., Bekkers, S., Arnstein, P. M., Smith, R. M., & Ring, D. (2014). Opioid use after
fracture surgery correlates with pain intensity and satisfaction with pain relief. Clinical
Orthopaedics and Related Research®, 472(8), 2542-2549.
Chaparro, L. E., Furlan, A. D., Deshpande, A., Mailis-Gagnon, A., Atlas, S., & Turk, D. C.
(2013). Opioids compared to placebo or other treatments for chronic low-back
pain. Cochrane Database Syst Rev, 8(8).
Choy, L. T. (2014). The strengths and weaknesses of research methodology: Comparison and
complimentary between qualitative and quantitative approaches. IOSR Journal of
Humanities and Social Science, 19(4), 99-104.
Kissin, I. (2013). Long-term opioid treatment of chronic nonmalignant pain: unproven efficacy
and neglected safety? Journal of Pain Research, 6, 513–529.
http://doi.org/10.2147/JPR.S47182

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Kobelt, P., Burke, K., & Renker, P. (2014). Evaluation of a standardized sedation assessment for
opioid administration in the post anesthesia care unit. Pain Management Nursing, 15(3),
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Lee, L. A., Caplan, R. A., Stephens, L. S., Posner, K. L., Terman, G. W., Voepel-Lewis, T., &
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665.
Wilder, C. M., Miller, S. C., Tiffany, E., Winhusen, T., Winstanley, E. L., & Stein, M. D. (2016).
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prescribed chronic opioids for addiction or pain. Journal of addictive diseases, 35(1), 42-
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Yilmaz, K. (2013). Comparison of quantitative and qualitative research traditions:
Epistemological, theoretical, and methodological differences. European Journal of
Education, 48(2), 311-325.
Zedler, B., Xie, L., Wang, L., Joyce, A., Vick, C., Kariburyo, F., ... & Murrelle, L. (2014). Risk
factors for serious prescription opioid-related toxicity or overdose among Veterans
Health Administration patients. Pain medicine, 15(11), 1911-1929.