NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence Based Approach TS

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence Based Approach TS


When it comes to creating evidence-based recommendations, nurses and other healthcare professionals struggle with the ability to search through several sources and pick a high-quality source. When researchers and practitioners use a PICOT inquiry, it is to help them define study objectives and goals. In order to do this, nurses must continually undertake research in order to increase their knowledge base on a certain issue or patient group, as well as conduct research in order to improve the quality of their care (Melnyk et al., 2010). When it comes to creating evidence-based recommendations, nurses and other healthcare professionals struggle with the ability to search through several sources and pick a high-quality source. To aid researchers and practitioners in identifying a particular study, PICOT questions are used. To have any influence on patient care, the nurse’s research should be guided by a set framework. There are a number of ways that this framework may help nurses come up with more focused clinical queries, to which finding reliable sources can potentially give solutions. It is a nursing evidence-based technique called PICO(T) for short (the time period may or may not be appropriate depending on the identified issue). PICO may be beneficial if you have fibromyalgia (T). In this article, the PICO(T) method will be used to treat persistent pain in fibromyalgia patients. (Riva et al., 2012).

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence Based Approach TS

Applying PICO(T) to Address Chronic Pain in Fibromyalgia

In addition to being a chronic and complex condition that affects primarily women, FM also has an adverse effect on quality of life (Dias de Farias et al., 2020; Han et al., 2020; Lawson, K., 2017; Rivas Neira, et al., 2017; Zamuner et al., 2019). Multi-symptomatic FM requires a multi-faceted treatment plan. However, non-pharmacological techniques are more often used to manage FM’s chronic symptoms than pharmaceutical approaches are to do so. Acupuncture and hydrotherapy exercise have been shown to improve quality of life in fibromyalgia patients when compared to the use of amitriptyline. So, the PICO(T) question would be: Is medication (such as amitriptyline) more accurate in treating the people with fibromyalgia compared with physiotherapy (such as acupuncture and hydrotherapy exercise) to reduce pain severity? 

Identified Evidence with Criteria/Rational

There are five reliable sources of evidence, according to FM and PICO(T) investigation.  In two out of the five sources, amitriptyline will be mentioned as a treatment option for FM. One source will discuss an acupuncture treatment for primary FM. Water therapy is the most effective treatment for people with many symptoms of FM.

On page 2 of their publication, Farias and colleagues (2020) state that FM is not well known, that it affects women more than men, and that it has a prevalence of 2.7 percent globally (p. (p. 4). When it comes to drug therapy, there have been eight studies that compare the efficacy of amitriptyline with duloxetine. There was a thorough evaluation of everything from safety to pain to sleep to fatigue to mood problems to overall quality of life in the research. 3.75 percent) of the reviews chosen indicated efficacy for pain and safety; for sleep problems, amitriptyline showed efficacy in one review (p 6).  15 of the eight reviews were deemed successful; amitriptyline performed better than duloxetine in terms of overall quality of life (p. 4); and amitriptyline was more effective than duloxetine in terms of weariness (p. 6).

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence Based Approach TS

A second publication by Lawson, K., (2017) addressed the use of amitriptyline to treat FM symptoms, as did the first. Females are more likely to have FMS, which is described as a “chronic multisymptomatic illness” with “widespread pain,” “depressive symptoms,” as well as “cognitive impairment,” by this source (p. 1). Because of its strong pain-relieving qualities, this medication is used as the first line of treatment. Depressive symptoms associated with FM have been proven to be effectively treated with the antidepressant amitriptyline (p. 1).

The medication of choice for FM is amitriptyline, according to Han et al. (2020), but its overall treatment outcomes are poor, as only a small number of patients benefit from it (p. 2). According to the authors, an acupuncturist is one of the non-pharmacological therapies for FM (p. 2). Following a four-week study that involved two 30-minute sessions each week, twice a week: inexpensive compared to multi-pharmaceuticals and frequent doctor visits or physical therapy, it improved blood flow and rapid pain alleviation for soft tissue diseases, and provided anti-inflammatory analgesic benefits as well (p. 2).

A study by Rivas Neira and co-workers (2017; Rivas Neira et al.) found that aquatic therapy was superior to land-based treatments for treating FM and managing the variety of somatic symptoms associated with chronicity and severity of FM. In a three-month study, women with FM aged 35 to 64 participated in 60-minute water and land-based exercises three times a week. Nothing else may be done during the study period. Participants who had physiotherapy showed improvements in aerobic capacity, flexibility and balance as well as better sleep quality and overall quality of life (pp. 5-8).

“Water treatment is one of the most recognized and crucial components of treating FM symptoms, according to Zamuner et al. (2019),” Scientists have discovered that soaking in a pool enhances muscle activation and range of motion as well as reducing fatigue, improving balance, reducing pain and morning stiffness, and enhancing general quality of life (pp. 1972-2001). In a 16-week study of warm water treatment, this was verified. As a result of the therapeutic effects of warm water, muscles were able to relax and joints were able to relax (pp. 1972-2001). A water treatment has been demonstrated to decrease pain, fatigue, and other discomforts, as illustrated in the examples above.

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence Based Approach TS

Relevance of Findings from Sources

For the compilation of this information, which was based on an examination of the sorts of treatments, both pharmaceutical and nonpharmacological, that have been employed in the treatment of chronic pain associated with FM, a large number of peer-reviewed articles were utilized. According to Dias de Farias and colleagues (2020), amitriptyline had less adverse effects than other tricyclic antidepressants, and drug cost was a factor in patients’ choice and final decision (p. 2). Amitriptyline was also shown to have low evidence for pain, moderate evidence for sleep and fatigue, and high evidence for quality of life (p. 7). When it comes to lowering pain and exhaustion as well as improving quality of life according to the second paper by Lawson, k. (p. 5). According to other sites, such as those listed below, amitriptyline is the best treatment for FM.

When it comes to non-pharmaceutical therapies such as Acupuncture, Han and colleagues (2010) argue that the advantages (mentioned above) are well-documented and enhance quality of life (p. 2). (p. 2). While both land-based and aquatic treatment have proven advantages in treating the symptoms of FM, water’s features make it one of the greatest venues to carry out an exercise program, according to a report by Rivas Neira et al., (2017). (2017). (p. 2). They also said that health experts feel that non-pharmacological therapy should be chosen over pharmaceutical treatment (p. 2). (p. 2). Water therapy, according to Zamuner et al. (2019), was 94% effective in decreasing the pain associated with FM (p. 1972). There are less adverse effects with water therapy, according to the authors, as well as it being less expensive in terms of healthcare and societal costs (p. 2002).

Findings Most Relevant to a Positive Outcome

To treat and alleviate the severe symptoms of FM, there are a number of treatment alternatives. Two out of five sources came to a positive conclusion, despite the fact that each source backed up their case with solid scientific facts. In 2017, Rivas Neira and colleagues found that hydrotherapy or water treatment exercises improved quality of life and alleviated FM symptoms, notably pain (Rivas et al., 2017). There’s little doubt that both the healthcare system and the patient benefit from aquatherapy since patients are more inclined to cooperate with treatment because their symptoms have improved and they require less doctor visits and less multi-pharmacotherapy expenses, according to both sources. Warm water treatment has been found to be more effective than medicine for pain alleviation (Rivas Neira et al., 2017, p. 2; Zamuner et al., 2019, p. 202). 

NURS FPX 4030 Assessment 3 PICOT Questions and an Evidence Based Approach TS


Acupuncture and hydrotherapy, in addition to other forms of physiotherapy, have been shown to enhance the overall quality of life of FM patients. Medical treatment for FM offers a few advantages, but physiotherapy has been proven to be the most successful in terms of efficacy, adverse effects, cost-efficiency, and increased physical health and well-being. Therefore, PICO(T) was utilized to direct the inquiry and offer factually important information to the investigators. 


Acet, G., Kaya, A., Akturk, S., & Akgol, G. (2017). A comparison of the effectiveness of amitriptilin and pregabalin treatment in fibromyalgia patients. Northern clinics of Istanbul4(2), 151.

Bhargava, J., & Hurley, J. A. (2021). Fibromyalgia. In StatPearls. StatPearls Publishing.

Farias, Á. D. D., Eberle, L., Amador, T. A., & Pizzol, T. D. S. D. (2020). Comparing the efficacy and safety of duloxetine and amitriptyline in the treatment of fibromyalgia: overview of systematic reviews. Advances in Rheumatology60.

Han, M., Cui, J., Xiao, Y., Xiao, D., Jiao, J., Peng, Q., … & Jiang, Q. (2020). Acupuncture for primary fibromyalgia: study protocol of a randomized controlled trial. Trials21(1), 1-9.

Lawson, K. (2017). A brief review of the pharmacology of amitriptyline and clinical outcomes in treating fibromyalgia. Biomedicines5(2), 24..

Neira, S. R., Marques, A. P., Pérez, I. P., Cervantes, R. F., & Costa, J. V. (2017). Effectiveness of aquatic therapy vs land-based therapy for balance and pain in women with fibromyalgia: a study protocol for a randomised controlled trial. BMC musculoskeletal disorders18(1), 1-10.

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association, 56(3), 167.

Zamunér, A. R., Andrade, C. P., Arca, E. A., & Avila, M. A. (2019). Impact of water therapy on pain management in patients with fibromyalgia: current perspectives. Journal of pain research12, 1971

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