Student name

Capella University

NURS-FPX8004 Advanced Doctoral Writing for Nurses

Professor Name

Submission Date

Annotated Bibliography

The issue of pain management is still of critical concern in an inpatient rehabilitation facility, and access to conservative interventions is a significant factor in the outcomes of patients. Adults placed in the specialized centers tend to have pain that is poorly managed, and this hinders their ability to engage in the key therapeutic processes (Janevic et al., 2025). The existing gaps in pain management protocols have a direct impact on key stakeholders, such as the nursing staff, physicians, patients, and administrative staff.

How does an opt-out policy of conservative pain management protocols (I) in nursing staff caring for adults who have been admitted to an inpatient rehabilitation facility (P), versus current practice (C), in terms of pain management response times (O) in 12 weeks (T)? The proposed QI project will improve the rates of participation in the therapeutic process, as well as the overall outcomes of rehabilitation, by providing access to evidence-based interventions in pain management in a timely manner.

Search Strategy

An extensive search of the literature was performed in various databases to find evidence-based interventions to manage pain in rehabilitation facilities. The keywords such as pain management, rehabilitation facilities, nonpharmacologic interventions, opioid reduction, collaborative care, and nursing interventions were adopted to search PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and PsycINFO databases. The search terms that included the use of the Boolean operators included terms like chronic pain and rehabilitation, pain protocols and nursing, and nonpharmacologic pain management and inpatient.

The preliminary search provided 247 articles in all databases. The inclusion criteria were the presence of peer-reviewed articles published between 2020-2025, adult populations in rehabilitation or healthcare facilities, and pain management or opioid reduction interventions. The articles that were excluded were those concerned with only acute care environments, children, or non-English speakers. Eight articles were kept that explicitly touched on the pain management interventions and collaborative care models, and relevant evidence-based approaches applicable in the inpatient rehabilitation facilities, and this gave a sound basis of understanding what the current best practices are that can be adopted in the management of pain in a conservative way.

Annotated Bibliography

Ashworth, J., Cornwall, N., Jinks, C., & Mallen, C. D. (2025). Evaluating a primary care pharmacist-led intervention to reduce opioid use for persistent non-cancer pain: The PROMPPT cluster randomised controlled trial protocol. National Institute for Health and Care Research Open Research. https://doi.org/10.3310/nihropenres.13441.1

The researchers presented a cluster randomized controlled trial that tested an intervention of primary care pharmacists to minimize opioid use in the management of persistent pain. The pragmatic trial design was a randomized trial of 38 general practices in England, either to the PROMPPT intervention or usual care. The intervention entailed the proactive clinical review of long-term opioid patients by training practice pharmacists using relevant training packages. The co-primary outcomes were a decrease in self-reported opioid use and no inferiority in pain interference scores at 12 months. The protocol assisted in adding to the field of literature by providing a framework for testing the pharmacist-led interventions in primary care contexts, which is necessary in the context of the real lack of evidence-based methods to decrease inappropriate long-term opioid prescriptions.

Clark, J. D., Bair, M. J., Lévy, I., Fitzsimmons, C., Zehm, L. M., Dougherty, P. E., Giannitrapani, K. F., Groessl, E. J., Higgins, D. M., Murphy, J. L., Riddle, D. L., Huang, G. D., & Shih, M. (2023). Sequential and comparative evaluation of pain treatment effectiveness response (SCEPTER), a pragmatic trial for conservative chronic low back pain treatment. Contemporary Clinical Trials, 125, e107041. https://doi.org/10.1016/j.cct.2022.107041

The authors attempted to find the best sequencing of the conservative treatment methods for veterans with chronic low back pain. The pragmatic randomized trial employed a stepped-care approach to recruit 2,529 participants in 20 Veterans Affairs medical sites in a two-phase intervention program. The first step will allocate the participants to three different treatments, namely digital self-management programs, individualized physical therapy interventions, or conventional care and systematic monitoring. The non-responding ones proceed to the second stage, where they are provided with cognitive behavioral therapy, chiropractic manipulation, or yoga. The study contributed to a considerable literature gap by offering empirical support to the existence of structured treatment sequencing in conservative pain management to develop a framework to conduct cost-effective and safety-centered stepped-care strategies in the population of veterans with chronic musculoskeletal issues.

Elphinston, R. A., Sterling, M., Leung, J., Gray, P. D., Requena, S., & Connor, J. P. (2021). Brief psychological interventions for reducing prescription opioid use, related harm, and pain intensity in patients with chronic pain: A systematic review and assessment of patient interest. The Clinical Journal of Pain, 37(4), 270-280. https://doi.org/10.1097/AJP.0000000000000908

The authors undertook a thorough review of short-term strategies in psychology that would reduce opioid prescribing and its related risks in patients with persistent pain. The researchers applied systematic review guidelines to assess the literature over 40 years (1980-2020) in five academic databases and finally included six qualifying investigations. An additional questionnaire given to 188 individuals who received prescribed opioids assessed the receptivity of patients to abridged psychological therapies. Results also indicated that all six studies evaluated in the review had evidence of treatment effectiveness in reducing opioid use or alleviating the negative effects of opioid use, but methodological quality was rather poor in most studies. The research contributed to the evidence base as it helped to understand the significant gap between patient eagerness to take part in the psychological interventions (92% said that they were willing to take part) and the dearth of high-quality research to back up such methods in chronic pain treatment.

Janevic, M. R., Lindsay, R., Brines, E., Wisdom, K., Lane, S. G., Brewer, R., Murphy, S. L., Piette, J., Grijalva, L., Anderson, M., Clement, J., & Latimer, C. (2025). A community health worker-delivered intervention (STEPS) to support chronic pain self-management among older adults in an underserved urban community: Protocol for a randomized trial. Trials, 26, e186. https://doi.org/10.1186/s13063-025-08892-w

The authors have outlined a randomized controlled trial that was used to test the chronic pain self-management intervention delivered by community health workers to older adults in deprived urban communities. The single-site parallel-group superiority trial randomized 414 participants who were 50 years of age and above to either the STEPS intervention or standard care control. The STEPS will be a 7-week program that involves the use of a pain self-management video and weekly phone calls with the community worker, activity tracking, and social needs assessment using community referrals. The primary outcome measures were pain interference that was accompanied by secondary outcome measures of pain intensity and global impression of change. The protocol served to support the research on health equity by tackling the problem of structural obstacles to pain care access among vulnerable groups, specifically African American older adults living under the influence of multiple social determinants of health issues.

Morasco, B. J., Pal, N., Ono, S. S., McPherson, S. M., Lynch, F. L., Dickerson, J. F., Dobscha, S. K., Krebs, E. E., Makris, U. E., & Mixon, A. S. (2024). Tele-collaborative outreach to rural patients with chronic pain: Pragmatic effectiveness trial protocol for the CORPs study. Pain Medicine, 25(1), 91-98. https://doi.org/10.1093/pm/pnae075

The authors outlined a multi-site pragmatic trial that explores the use of team-based care in the management of severe chronic pain in rural Veterans using telehealth methods. The controlled trial study randomized 608 participants to four locations and allocated subjects randomly to either the Tele-Collaborative Outreach to rural patients (CORPs) program or the simple care with slight improvement. The CORPs program included full biopsychosocial assessment, session-based, formal interactions with nursing care coordinators, specialist physician consultation, and group-based virtual education on pain management. The primary endpoint involved the pain-related functional interference that included the planned measurements of the implementation processes and the economic results. The protocol contributed to the solution of the rural healthcare access disparities through the development of evidence-based models of providing the geographically isolated communities with specialized pain management services through the development of novel remote care delivery models.

Rogers, D. G., Frank, J. W., Wesolowicz, D. M., Nolan, C., Schroeder, A., Falker, C., Abelleira, A., Moore, B. A., Becker, W. C., & Edmond, S. N. (2023). Video-telecare collaborative pain management during COVID-19: A single-arm feasibility study. BioMed Central Primary Care, 24, e134. https://doi.org/10.1186/s12875-023-02052-2

The authors of the quality improvement study determined the feasibility and acceptability of a virtual collaborative pain management program (VCPM) for patients with high-dose chronic opioid therapy in the United States to access the study. The uncontrolled feasibility study was used before and after approach of research with a total of 133 respondents obtained in two Veterans Health Administration centers. VCPM intervention assists in combining medication reconsideration and dose minimization, buprenorphine transfer methods, ongoing observation, and cognitive-behavioral self-management measures that are performed by the clinical pharmacists.

Results have proven that 84 percent of veterans who attended several sessions managed to switch to buprenorphine or reduce opioid dose levels, with significant morphine equivalent daily dosing reductions. The study contributed to the essential implementation science evidence of the feasibility of remote multidisciplinary pain management implementation during the time of the public health crisis, and the evidence of complex telehealth intervention in the context of limited health care resources is provided.

Sellinger, J. J., Martino, S., Lazar, C., Mattocks, K., Rando, K., Serowik, K., Ablondi, K., Edens, E. L., Brandt, C. A., Hoff, R. A., Haskell, S. G., & Becker, W. C. (2021). The acceptability and feasibility of screening, brief intervention, and referral to treatment for pain management among New England veterans with chronic pain: A pilot study. Pain Practice, 22(1), 28-38. https://doi.org/10.1111/papr.13023

The research study was useful in testing the feasibility and patient acceptability of a screening, brief intervention, and referral to treatment model, specially tailored to help manage chronic pain in veterans seeking disability benefits (SBIRT-PM). In the uncontrolled pilot study, 40 veterans were recruited in eight medical centers in New England and provided up to four counseling sessions through telephone, based on motivational interviewing techniques.

The program provided educational information and facilitated to take part in the initiative for pain management for veterans who are currently involved in two or fewer veteran affairs (VA) pain management options. Results indicated 80 percent attendance at a minimum of one counseling session, 90 percent of study participants completed 12-week follow-ups, and were satisfied to have learned about pain care resources and counselor support. The preliminary evidence taken by the author to adapt screening, brief intervention, and referral models to the context of pain management showed the viability of motivational interviewing strategies to enhance treatment attendance among Veterans with co-occurring pain and substance use problems.

Wilson, M., Dolor, R. J., Lewis, D., Regan, S. L., Meulen, M. B., & Winhusen, T. J. (2023). Opioid dose and pain effects of an online pain self-management program to augment usual care in adults with chronic pain: A multisite randomized clinical trial. Pain, 164(4), 877-885. https://doi.org/10.1097/j.pain.0000000000002785

The authors analyzed the possibility of decreasing the use of opioids and managing the pain in long-term opioid therapy adults using an online pain self-management program. It was an open-label, intent-to-treat, randomized clinical trial that recruited 402 subjects in two academic health systems (primary care and pain clinics). The goal of the chronic pain management program and treatment as usual were randomly selected to be used on the participants. The findings showed that 53.6 percent of intervention subjects experienced [?]15 percent decrease in dose of morphine as daily doses with respect to 42.3 percent of control subjects. The purpose of the study was to make a significant contribution to the literature on pain management through objective evidence that online self-management programs can be used to achieve a clinically significant dose of opioid reduction and, at the same time, lead to better pain outcomes.

Conclusion

The synthesis of the existing evidence on pain management interventions in rehabilitation and healthcare institutions in the annotated bibliography has shown that the focus on nonpharmacologic methods and the development of collaborative models of care continue to be a unanimous priority. The literature review proves the effectiveness of the intervention strategies that involve self-management education, telehealth methodologies, and interdisciplinary teams to decrease the degree of opioid dependence without causing the loss of effective pain management. The available research findings have perpetually indicated that short-term psychological interventions, community health worker-based programs, and pharmacist-led evaluations may result in significant decreases in opioid use without affecting pain outcomes. The details justify the use of the stepped-care models, where non-escalative interventions are used first, followed by the more intensive ones, which corresponds to the modern clinical practice standards, which focus on patients and evidence-based practices.