Pain control is a number one priority in the patient satisfaction scores for the Emergency Departments. With patient satisfaction survey scores driving how healthcare is being performed many physicians feel pressured to prescribe to customer satisfaction instead of medical necessity. (Zgierska, Miller, Rabago, &, 2013) Prescribing opioids in this manner has caused an epidemic of opioid dependence. The deaths from narcotics are superseding the deaths from suicide and motor vehicle accidents. (Manchikanti et al., 2012) The government is now monitoring prescriptions of opioid prescribing and more patients are coming to the Emergency Department (ED) due to the need for pain control and due to opioid addiction. Physicians are looking for a non-opioid pain relief. Ketamine has started to appear in the emergency room for an alternative route for opioid abusers. Pain Control Research Assignment paper
Alternative uses for non-opioid pain relief in the emergency rooms have incorporate low doses ketamine (LDK) to assist with acute pain, chronic pain, and refractory pain. Adverse effects to ketamine results in dizziness, nausea, vomiting, mild hallucinations or agitation. (Pourmand, Mazer-Amirshahi, Royall, Alhawas, & Shesser, 2017) There are different types of psychological factors that can have detrimental effects on patients being given ketamine for pain control. According to Bokor and Anderson, “ketamine can alter numerous functions in the brain including color perception, memory, attention, cognition, reaction time, and sense of time can produce psychological addiction” (Boker & Anderson, 2014) Ketamine is a scheduled class III drug which potentiates the likely increase for abuse and addiction. (American Addiction Centers, 2018). Knowledge of the side effects and levels of abuse the patient can develop from ketamine are concerning for another rising type of addiction to start in the medical field. Currently ketamine is a recreational drug on the streets known as the “date rape drug”. (American Addiction Centers, 2018) The rationale to utilize ketamine instead of opioids is in need of recurring research to ensure safe prescribing for patients. Pain Control Research Assignment paper
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In developing my clinical question, I utilized the formula of patient, intervention, comparison, and outcome. I then was able to develop the question, Is Ketamine a safe effective alternative to pain relief in the Emergency Department for opioid abusers? The patient criteria of the question involve the group of opioid abuser. The problem is the need for an alternate non-opioid pain management for patients who have history of opioid abuse. The alternative needs to be a safe alternative to pain management and not just a cover up or another drug to start an addiction. The intervention is giving low doses of ketamine for pain management to opioid abusers. The comparison component is substituting opioids for low-dose ketamine. The outcome component is highly important, are we managing patients pain safely or is being prescribed ketamine fueling another type of addiction.
Deciding on the five questions I have developed involved understanding the reasoning, safety, and effects of giving ketamine. Patient safety is the number one priority. One correlation I perceived is are we going to be seeing more people returning to the ED for ketamine? Is this going to be another type of addiction for opioid abuser? To understand and research the problem I have developed these five questions:
What is the mechanism of action for ketamine to provide pain relief?
What are side effects of ketamine?
Is ketamine addictive?
Should ketamine be given on a patient’s own pain scale rating?
When should ketamine be contraindicated?
Question one was developed with needing to know knowledge on how ketamine provides pain relief in the body. This can be beneficial in knowing how the drug will affect the patient. Question two is needing to be researched for patient safety. Side effects can be synergistic to other diagnosis’s the patient may have. Question three is beneficial in understanding ketamine addiction could be a prevalence for patients with opioid abuse to also become addicted to ketamine. Question 4 rational includes understanding the pain scale and when to give ketamine is being given for pain. Should this be a common substitute for acute pain? Should there be other factors to patient reaction when deciding when to give ketamine besides patient’s pain scale rating. Drug abusers will tell you they have a pain of 10 to try and ensure having opioids prescribed to them. Question 5 is indicative to understanding if it is safe or not safe to given in situations when patients present with multiple diagnosis including history of addiction.
Keywords are important in researching the best evidence reviews and practice for developing an outcome to your PICO question. Keywords that I chose to utilize for my database search includes; low dose ketamine, opioid abuse, pain management, adverse effects, drug seekers, analgesia, addiction, acute pain, emergency department, and subdissociative dose ketamine. The keyword chosen correlates to the significance of the PICOT question. The low dose ketamine and subdissociative dose ketamine is the dosage that would be given to patients who need acute pain management. Opioid abuse, drug seekers, and addiction are pertinent words to understand the reasoning for the need of an alternate solution to opioids. Pain management, analgesia, acute pain is the types of pain or synonyms for the research of pain management in the Emergency Department for opioid abusers. The keyword Emergency Department is important in understanding the location and setting where the patient is being given ketamine. Knowledge of adverse effects of ketamine can play an important role in understanding if the medication is safe to give in an ED setting. Pain Control Research Assignment paper
Knowledge of ketamine can further inquire on the safety with administration of ketamine. Correlating side effects, adverse effects, and mechanism of action will allow for a base understanding of the scientific purpose for treating pain with ketamine. Further investigation and research needs to be applied in relevance to the later effects of using this type of drug for pain control.
American Addiction Centers. (2018). Can ketamine be abused and cause withdrawal? Retrieved from https://americanaddictioncenters.org/ketamine-abuse/
Boker, G., & Anderson, P. (2014, March 20). Ketamine: An update on its abuse. J Pharm Pract, 27(6), 582-586. http://dx.doi.org/10.1177/0897190014525754
Manchikanti, L., Helm, S., Fellows, B., Janata, J. W., Pampati, V., Grider, J. S., & Boswell, M. V. (2012, July). Opioid epidemic in the united states. Pain Physician, 15, ES9-ES38. Retrieved from http://www.painphysicianjournal.com/current/pdf?article=MTcwNA==&journal=68
Pourmand, A., Mazer-Amirshahi, M., Royall, C., Alhawas, R., & Shesser, R. (2017, March 2). Am J Emerg Med. Low dose ketamine use in the emergency department, a new direction in pain management, 35(6), 918-921. http://dx.doi.org/10.1016/j.ajem.2017.03.005
Zgierska, S., Miller, M., & Rabago, D. (2013, February 25). Patient satisfaction, prescription drug abuse, and potential unintended consequences. JAMA, 307(13), 1377-1378. http://dx.doi.org/10.1001/jama.2012.419
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