5069 -Module 4 The Value of Information and Costs Homework 4 Class, Do a search on the internet and find a company that does this well reliability measures, and write up a page telling me what this company does and why it does well with this area. Running head: PAIN MANAGEMENT AND ADDICTION 1 PAIN MANAGEMENT AND ADDICTION 7 Pain Management and Addiction Name Institution Pain Management for Patients with Addiction Problems Thesis Statement The ability of clinicians to keep patients in check has proven to be a challenge, especially with concerns regarding the legitimacy and physical functions affecting overall pain management in patients with an addiction problem. Background The treatment modalities for chronic pain using COT in active drug users or those who are in remission presents a significant challenge for clinicians who oversee the effectiveness of the intervention. Moreover, such notions are correlated to the concerns of patients experiencing a relapse to substance abuse during the duration of therapy since analgesics may obscure drug seeking behaviors that are characteristic of addictive diseases. This results in poor treatment outcomes where patients are likely to be discharged prematurely from pain care treatment. Additionally, there is the widespread misconception that chronic pain patients with an addiction problem often encounter health professionals who possess inadequate training in clinical guidelines that are related to comorbidities of chronic pain and related addiction issues. Moreover, there exists a dilemma for the treatment of abstinent and former heroin addicts as they are at a high risk of relapsing to addiction if they are exposed to opioid drugs. They also face the risk of relapsing if they are not accorded sufficient care. For people who are already on opioid medication such as methadone often experience challenges responding to pain relievers when they are hospitalized. In such as case, the fundamental principle of management denotes the prevention of withdrawals by initiating methadone for heroin users while providing additional analgesia as recommended while confirming whether the pain relief is satisfactory. Additionally, most physicians have developed a phobia of overprescription of narcotics as pain relievers. Perhaps this may be attributed to the fear of the legal repercussions that may ensue including the divergences in federal guidelines on matters about use of narcotics as a pain reliever. Thus, it is the responsibility of the individual practitioner to offer pain management using opioids for legitimate standard and by the regulation of medical practice. Objective The purpose of this research is to evaluate the challenges that are faced by clinicians in pain treatment for patients with addiction problems. On the other hand, the study focuses on offering a counter argument to the thesis by providing ideal solutions for pain management for patients with SUDs. Additionally, the rese.

1. 5069 -Module 4 The Value of Information and Costs
Homework 4
Class,
Do a search on the internet and find a company that does this
well reliability measures, and write up a page telling me what
this company does and why it does well with this area.
Running head: PAIN MANAGEMENT AND ADDICTION 1
PAIN MANAGEMENT AND ADDICTION 7
Pain Management and Addiction
Name
Institution

2. Pain Management for Patients with Addiction Problems
Thesis Statement
The ability of clinicians to keep patients in check has proven to
be a challenge, especially with concerns regarding the
legitimacy and physical functions affecting overall pain
management in patients with an addiction problem.
Background
The treatment modalities for chronic pain using COT in active
drug users or those who are in remission presents a significant
challenge for clinicians who oversee the effectiveness of the
intervention. Moreover, such notions are correlated to the
concerns of patients experiencing a relapse to substance abuse
during the duration of therapy since analgesics may obscure
drug seeking behaviors that are characteristic of addictive
diseases. This results in poor treatment outcomes where patients
are likely to be discharged prematurely from pain care
treatment. Additionally, there is the widespread misconception
that chronic pain patients with an addiction problem often
encounter health professionals who possess inadequate training
in clinical guidelines that are related to comorbidities of
chronic pain and related addiction issues. Moreover, there exists
a dilemma for the treatment of abstinent and former heroin
addicts as they are at a high risk of relapsing to addiction if
they are exposed to opioid drugs. They also face the risk of
relapsing if they are not accorded sufficient care. For people
who are already on opioid medication such as methadone often
experience challenges responding to pain relievers when they
are hospitalized. In such as case, the fundamental principle of
management denotes the prevention of withdrawals by initiating
methadone for heroin users while providing additional analgesia
as recommended while confirming whether the pain relief is
satisfactory. Additionally, most physicians have developed a
phobia of overprescription of narcotics as pain relievers.
Perhaps this may be attributed to the fear of the legal

3. repercussions that may ensue including the divergences in
federal guidelines on matters about use of narcotics as a pain
reliever. Thus, it is the responsibility of the individual
practitioner to offer pain management using opioids for
legitimate standard and by the regulation of medical practice.
Objective
The purpose of this research is to evaluate the challenges that
are faced by clinicians in pain treatment for patients with
addiction problems. On the other hand, the study focuses on
offering a counter argument to the thesis by providing ideal
solutions for pain management for patients with SUDs.
Additionally, the research intends to highlight the complex
interconnection that exists between pain management and
addiction to opioids.
Supporting Points
1. Pain management and Addiction Endure a Complex
Interaction
a. Opioid drugs are the nerve center of chronic pain
management and the incorporation of the modalities such as
COT augments the risk of relapse to addiction in patients with a
history of SUDs due to the susceptibility to drug seeking
behavioral patterns.
b. Patients struggling with SUDs are more likely to be
discharged early from pain management care which would
ultimately culminate in the prevalence of addiction problems
due to drug dependency (Martell et al., 2007).
c. Stigma by clinicians has also emerged as a major contributor
towards inhibiting the effective pain treatment of patients with
SUDs as a result of ineffective communication and lack of
utilization of collaborative efforts during treatment.
2. Controversy Surrounds the Level of Opioid Dosage
a. There exists limited evidence from randomised control trials
or observational studies on the appropriate pain management
techniques for patients with a history of addiction problems.

4. b. Patients who are currently on opioids face challenges usually
experience difficulties in pain management when they are
hospitalized. The victims’ predicament prompts clinicians to
augment the dosage in a bid to achieve the desired outcomes,
and such an approach bears ethical connotations (Michna et al.,
2004).
c. Moreover, physicians are often cautious in regards to opioid
treatment due to the legal issues that may occur in the event of
oversubscription.
3. Pain Management in Health Care Setting
a. The management of acute pain for hospitalized patients
require written procedures and policies to implement the
treatment intervention for patients who struggle with SUDs.
b. Most health care settings lack support for individual
practitioners who are expected to address the issues associated
with complex problems of seemingly stigmatized patients. This
may be characterized by the absence of a consultation-liaison
service and an acute pain management team (Gourlay, Heit &
Almahrezi, 2005).
c. Many addicts experience chronic pain, and the subsequent set
up of addiction services and pain clinics necessitates the need to
incorporate concerted effort in chronic pain management for
drug abusers.
Counter Arguments
1. The categorization of the level of pain the patient is
experiencing aids in determining the dosage of pain medication
that is to be administered.
2. Administration of pain medication ought to be scheduled as
the escalation of pain leads to the requirement of more
medication to regulate the discomfort (Thorn, 2017).
3. Structured control of opioid medication access is essential in
decreasing chances of opioid addiction including arranging for
the distribution of drugs from someone other than the patient

5. (Chou et al., 2009).
Response to Counter Arguments
1. According to the World Health Organisation (WHO), the
application of the step ladder approach is instrumental since the
classification of pain helps avert instances of oversubscribing
(Fishbain et al., 2007).
2. Ensuring compliance of scheduled administration of opioids
aids in decreasing the chances of drug dependence including
increasing the assurances of a timely recovery (Ives et al.,
2006).
3. The structured control of access to medication will aid in
averting clinician-patient conflict which is mostly instigated by
drug seeking behaviors (Ballantyne & Mao, 2003).
Implications
The management of chronic pain in patients with a history of
SUDs can be quite challenging and although there are no right
answers in a conventional model of administration and
assessment may be achieved to enhance the quality of life and
functionality. This may be accomplished through the use
concerted efforts amongst health professionals in the
prescription of opioids for patients who are susceptible to
addiction. In a hospital setting, the organization may
incorporate consultancy services where a team of experts is
actively involved in identifying and diagnosing drug
dependency in a patient.

6. Tentative Bibliography
Ballantyne, J. C., & Mao, J. (2003). Opioid therapy for chronic
pain. New England Journal of Medicine, 349(20), 1943-1953.
Chou, R., Fanciullo, G. J., Fine, P. G., Adler, J. A., Ballantyne,
J. C., Davies, P., ... & Gilson, A. M. (2009). Clinical guidelines
for the use of chronic opioid therapy in chronic noncancer
pain. The Journal of Pain, 10(2), 113-130.
Fishbain, D. A., Cole, B., Lewis, J., Rosomoff, H. L., &
Rosomoff, R. S. (2007). What percentage of chronic
nonmalignant pain patients exposed to chronic opioid analgesic
therapy develop abuse/addiction and/or aberrant drug-related
behaviors? A structured evidence-based review. Pain
medicine, 9(4), 444-459.
Gourlay, D. L., Heit, H. A., & Almahrezi, A. (2005). Universal
precautions in pain medicine: a rational approach to the
treatment of chronic pain. Pain Medicine, 6(2), 107-112.
Ives, T. J., Chelminski, P. R., Hammett-Stabler, C. A., Malone,
R. M., Perhac, J. S., Potisek, N. M., ... & Pignone, M. P.
(2006). Predictors of opioid misuse in patients with chronic
pain: a prospective cohort study. BMC health services
research, 6(1), 46.
Martell, B. A., o'Connor, P. G., Kerns, R. D., Becker, W. C.,
Morales, K. H., Kosten, T. R., & Fiellin, D. A. (2007).
Systematic review: opioid treatment for chronic back pain:
prevalence, efficacy, and association with addiction. Annals of
internal medicine, 146(2), 116-127.
Michna, E., Ross, E. L., Hynes, W. L., Nedeljkovic, S. S.,
Soumekh, S., Janfaza, D., ... & Jamison, R. N. (2004).
Predicting aberrant drug behavior in patients treated for chronic

7. pain: importance of abuse history. Journal of pain and symptom
management, 28(3), 250-258.
Thorn, B. E. (2017). Cognitive therapy for chronic pain: a step-
by-step guide. Guilford Publications.
Running head: ANNOTATED BIBLIOGRAPHY 1
ANNOTATED BIBLIOGRAPHY 2
Annotated Bibliography
Student’s Name
Institution

8. Thesis Statement
The ability of clinicians to keep patients in check has proven to
be a challenge, especially with concerns regarding the
legitimacy and physical functions affecting overall pain
management in patients with an addiction problem.
Annotated Bibliography
Chou, R., Cruciani, R. A., Fiellin, D. A., Compton, P., Farrar, J.
T., Haigney, M. C., ... & Mehta, D. (2014). Methadone safety: a
clinical practice guideline from the American Pain Society and
College on Problems of Drug Dependence, in collaboration with
the Heart Rhythm Society. The Journal of Pain, 15(4), 321-337.
Discrepancies surrounding the safety of methadone as a
treatment measure for chronic pain have raised questions
particularly due to the prevalence of deaths that result from the
methadone overdose. Consequently, the American Pain Society
in collaboration with College on Problems of Drug Dependence
has prepared this report with the aim of creating a clinical
practice guideline to ensure safer prescription of methadone in
pain treatment. Moreover, the findings have culminated in
recommendations that include the use of electrocardiography to
identify patients who are likely to succumb to methadone-
associated arrhythmia and education and counseling of patients
on methadone safety.
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC
guideline for prescribing opioids for chronic pain—the United
States, 2016. Jama, 315(15), 1624-1645.
More often than not, primary care clinicians experience
challenges in regards to management of chronic pain amongst
patients with a history of addiction. Additionally, there is a
widespread limitation of the long-term efficacy of opioids in
pain management. Opioid use is also associated with grave risks
that comprise of the possibility of an overdose and the advent of
opioid use disorder. As a result, this journal article focuses on
highlighting the ideal recommendations on the administration of
Chronic Opioid Therapy (COT) as perceived by the Center for

9. Disease Control and Prevention (CDC). Further, this research
focuses on the consideration of non-opioid therapy as an
alternative including the assessment of the treatment goals of a
patient and the correct procedures for administering opioid
dosage.
Milton, J. (2013). Caring for patients with chronic pain: pearls
and pitfalls. The Journal, 113(8), 620.
Indeed, chronic non-malignant pain has been the subject of
debate in public health in the U.S. Hence; this paper focuses on
defining chronic pain based on the biopsychosocial model which
concentrates on the psychological and biological makeup of
patients and how they interact with their cultural and social
environment. Although such an approach is based on the
pathology of chronic pain, the physician also plays significant
role through management and assessment of patient safety
during therapy. Moreover, the clinicians are expected to be
conversant with the evaluation tools that are applied in the
scrutiny of the risk of opioid use. The fundamental
comprehension of chronic pain pathophysiology and an even
structure towards patient care is essential in satisfying the needs
of both physicians and patients.
Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., Ney, J.
P., & van der Goes, D. N. (2015). Rates of opioid misuse,
abuse, and addiction in chronic pain: a systematic review and
data synthesis. Pain, 156(4), 569-576.
The use of opioids in chronic pain management presents
complexities in the sense that patients are susceptible to derive
both harm and benefits from the drugs administered. Thus, this
review offers an expanded information in regards to the rates of
problematic opioid use in chronic pain. Some of the identified
factors that contribute to the problematic use of opioids include
the different patterns of drug use and the prevalence rates
following the proliferation of prescriptions amongst patients.

10. Running head: PAIN MANAGEMENT AND ADDICTION 1
PAIN MANAGEMENT AND ADDICTION 3
Pain Management and Addiction
Name
Institution
Thesis Statement
The ability of clinicians to keep patients in check has proven to
be a challenge, especially with concerns regarding the
legitimacy and physical functions affecting overall pain
management in patients with an addiction problem.
There exists a contentious debate surrounding the pain
management in individuals who have a history of addiction
problems. The advent of this deliberation may be attributed to
the fact clinicians are often in a dilemma especially in the
application of chronic opioid therapy (COT) and the
interactions with substance use disorders (SUDs) (Kaasalainen

11. et al., 2007). Moreover, studies propose behavioural
symptomatology of chronic pain and addiction are interrelated
such that if one disorder is left untreated, the efficacy of
treatment in the other is virtually impossible. In essence, the
incomplete comprehension this unique interaction coupled with
the inadequate management of both conditions culminated in the
under-treatment of pain and untimely discharge of SUD patients
from pain treatment. Consequently, in a bid to realize optimal
physical functionality and pain relief, both conditions ought to
be considered for treatment. The proper management of pain in
the population of patients with SUDs is critical since poor
management may result in dire consequences such as
compromised medical care, relapse to addiction and the
likelihood of grace toxicity as a result of mistaken tolerance or
drug addictions (Coulter, 2011). The stigma that is associated
with addiction also serves to compound on the pain management
techniques to be applied to the faction of patients with SUDs.
This occurrence may lead to the discontented interaction
between an addict and the healthcare system
On the other hand, suggestions have been presented that there
are no correct answers when it comes to management of pain.
Nonetheless, a convention model that would enable clinicians to
address the issue of pain management in SUD patients involves
having one clinician prescribe the pain medication; sufficient
knowledge in opioid pharmacology and development of a
collaborative treatment plan (Sehgal, Manchikanti & Smith,
2012). Moreover, the clinician may employ attitudes such as
being empathetic and non-judgemental to addicts in pain
therapy including the establishment of effective communication
to discuss the underlying risks and to contain distress.
Supporting Points
• The categorization of the level of pain the patient is
experiencing aids in determining the dosage of pain medication
that is to be administered.
• Administration of pain medication ought to be scheduled as
the escalation of pain leads to the requirement of more

12. medication to regulate the discomfort. (Thorn, 2017).
• Structured control of opioid medication access is essential
in decreasing chances of opioid addiction including arranging
for the distribution of drugs from someone other than the
patient (Chou et al., 2009).
References
Coulter, A. (2011). Engaging patients in healthcare. McGraw-
Hill Education (UK).
Chou, R., Fanciullo, G. J., Fine, P. G., Adler, J. A., Ballantyne,
J. C., Davies, P., ... & Gilson, A. M. (2009). Clinical guidelines
for the use of chronic opioid therapy in chronic noncancer
pain. The Journal of Pain, 10(2), 113-130.
Kaasalainen, S., Coker, E., Dolovich, L., Papaioannou, A.,
Hadjistavropoulos, T., Emili, A., & Ploeg, J. (2007). Pain
management decision making among long-term care physicians
and nurses. Western journal of nursing research, 29(5), 561-
580.
Sehgal, N., Manchikanti, L., & Smith, H. S. (2012). Prescription
opioid abuse in chronic pain: a review of opioid abuse
predictors and strategies to curb opioid abuse. Pain
physician, 15(3 Suppl), ES67-ES92.
Thorn, B. E. (2017). Cognitive therapy for chronic pain: a step-
by-step guide. Guilford Publications.
Note Taking and Summary

13. NOTE TAKING AND SUMMARY
Erica K. Fernandez
Argosy University
After completing the note taking activity, I found the Cornell
note taking strategy to be a more convenient strategy to utilize
while reviewing reading material. I tend to use the informal
outline method which in my opinion makes notes easier and
quicker to take in a faster paced setting. With the Cornell
strategy, I do believe in a classroom setting this method may be
more difficult to utilize as it allows you to summarize the most
important information so that you may note those key points. In
my personal opinion, this may work best when you are able to
review content prior to having a discussion. In addition to this,
the summary portion allows you to create a grand concept from
the notes and ideas which are outlined rather than when you just
list them for later review. The activity also allowed me to take
ownership and really think about the concepts I would list. I
saw this as a great tool to use to reinforce comprehension of the
content. This would be very beneficial in creating short essays
and/or answering essay questions.

14. In the future, I will most likely use more note taking
strategies in the work place and most of my continued education
courses. A lot of my work activities are very hands on and fast
paced which results in my notes being much more unorganized.
By having unorganized notes, it makes it at times difficult to
review and recite. By using more organized methods and going
back to revise, (a strategy I would fail to complete) it will make
it easier to recall information, as well as gain the ability to
recognize information with future similar subjects.
1