A quality improvement project successfully improved pain control and increased use of nonpharmacological pain management strategies among trauma patients using medication-assisted therapy (MAT) to manage opioid use disorder (OUD), according to results of a study presented at the 2022 American Association of Nurse Practitioners (AANP) National Conference held June 21 to June 26, 2022, in Orlando, Florida.1 The article was also published in The Journal of the American Association of Nurse Practitioners.2

In 2018, 10.3 million opioids were misused, and 1.27 million individuals used MAT for OUD, explained study author Kimberly Broughton-Miller, DNP, FNP-C, ENP-C, FAANP. Managing acute pain among patients receiving MAT remains a significant unmet need as this population has increased pain sensitivities and opioid requirements, she said.

High Pain Levels, Underuse of Nonopioid Pain Strategies

At baseline, 20% of trauma patients on MAT at the University of Louisville Hospital achieved pain scores of 5 or less on a 10-point scale, 10% had nonpharmacological pain management techniques incorporated into care, and the average pain score was 8. Although approximately 70% of these patients were prescribed acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), “only 25% of available as-needed doses for acetaminophen and 27% for NSAIDs were administered,” Dr Broughton-Miller explained. Only 21% of patients had MAT incorporated into pain regimens.

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This quality improvement study aimed to improve the percentage of trauma patients on MAT with a pain level of 5 or less to 50% and increase the percentage of patients who elect to use nonpharmacological pain management to 50%. The intervention consisted of a risk assessment tool, shared decision-making tool, provider checklist, and team engagement plan. A total of 50 trauma patients were treated using this intervention over the 90-day study period.

Mean Pain Scores Decreased by Nearly Half

Mean pain scores improved markedly after instituting the intervention and the overall mean pain score for the entire 90-day period was 4.8. Nearly three-quarters of patients (74%) reported pain scores of 5 or less, representing a 54% improvement over the baseline rate (Figure).

Figure. Change in percentage of patients with pain scores of 5 or less. Reprinted with permission from Dr. Broughton-Miller.

The percentage of patients who elected to include nonpharmacological pain management strategies in their treatment regimens increased to 91% and the need for opioid reversal decreased by 50% compared with baseline levels. “The most common of these strategies selected by patients, in order of preference, were pet therapy, art therapy, music therapy, ice, or positioning,” Dr Broughton-Miller said.

The study investigators observed that using the provider checklist comprising recommendations from the 2020 American Society of Addiction Medicine (ASAM) and Substance Abuse and Mental Health Services Administration (SAMHSA) increased the number of patients taking NSAIDs to 92%. Two-thirds of patients (76%) resumed MAT use.

Patient engagement in shared decision-making was strongly correlated with pain control, Dr Broughton-Miller said. An increase in patient engagement was found following pharmacist-led education sessions with patients. Use of the risk assessment tool increased after inclusion of nursing staff in administering the assessment during the admissions process, Dr Broughton-Miller added.

A limitation of this study was that it was conducted during the COVID-19 pandemic, which may have affected the outcomes. Additionally, the electronic version of the assessment tool could not be integrated into the hospital’s electronic medical records and instead was provided in paper format, which resulted in increased steps in the staff’s workflow.

The tools used in this program successfully improved pain management and facilitated the use of nonpharmacological medications among trauma patients using MAT for OUD, Dr Broughton-Miller concluded. This targeted intervention could be translated to other patient populations, such as acute surgical care in the setting of MAT for OUD, Dr Broughton-Miller added.

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Broughton-Miller K. Effective patient-centered acute pain management of trauma patients on medication-assisted therapy (MAT). Presented at: AANP 2022; June 21-26, 2022; Orlando, Fl.

Broughton-Miller KD, Urquhart GE. Improving acute pain management of trauma patients on medication-assisted therapy. J Am Assoc Nurse Pract. 2022 Jul 1;34(7):924-931. doi:10.1097/JXX.0000000000000730