Defining opioid tolerance and dependency

Virtual Reality Based Guided Meditation for Patients with Opioid Tolerance and Opioid Use Disorders

BACKGROUND

The management of acute pain in patients with pre-existing opioid tolerance or opioid use disorders presents unique challenges. In light of the concerns regarding opioid use, safe and effective alternatives to opioid medications are of increasing interest.

AIMS

This study was conducted to determine if the use of guided meditation delivered through immersive virtual reality can reduce pain in patients with opioid tolerance or opioid use disorders, including opioid abuse or opioid dependence.

DESIGN

A quasi-experimental pre-test and post-test study design was used.

SETTINGS

A 31-bed inpatient orthopedic/trauma unit in the southeastern United States.

PARTICIPANTS/SUBJECTS

Subjects of the pilot study were hospitalized adults over the age of 18 with pre-existing opioid tolerance or opioid use disorder who were experiencing acute pain.

METHODS

This pilot study examined the effect of a 10-minute guided meditation activity through immersive virtual reality on the reported acute pain of hospitalized adults (n = 11) with pre-existing opioid tolerance or opioid use disorders. The Calm® application on an Oculus Go® virtual reality head-mounted display was used for the meditation activity.

RESULTS

Before the intervention, the mean patient-reported pain rating was 6.68, and the mean pain score after the virtual reality experience was 3.36. Using the Wilcoxon signed rank test, this was a statistically significant difference (p = .003). Patients were also observed and queried regarding any significant side effects or other incidental findings, none of which were reported.

CONCLUSIONS

This study demonstrates that the use of guided meditation through virtual reality can result in statistically significant reductions in patient-reported pain scores.

Nurses' competence in pain management in patients with opioid addiction: A cross-sectional survey study

BACKGROUND

There may be up to 21 million opioid abusers in the world. Drug abuse and associated health-related problems are increasing. Opioid addiction can cause serious bacterial infection, injury and trauma, conditions that can trigger pain. Opioid abusers experience pain differently from non-addicts. There is limited research on nurses' competence to provide pain treatment to patients with opioid addiction.

OBJECTIVE

To report on a Norwegian pilot study examining nurses' knowledge about pain and competence in treating pain in patients who abuse opioids.

DESIGN

A descriptive cross-sectional survey design was employed.

PARTICIPANTS

Nurses at medical (n=64) and orthopaedic (n=34) units at two urban, public Norwegian hospitals.

METHODS

Data were collected in January 2010 using a self-administered questionnaire. Sample selection was determined by purposive sampling. The response rate was 54%.

RESULTS

Eighty-eight percent of nurses did not have sufficient knowledge about pain treatment in patients with opioid addiction. Eight-eight percent and seventy-seven percent regarded work-place experience and colleagues as the primary contributors to their knowledge about pain treatment, respectively. Work-place experience contributed most to nurses' competence. Ninety percent, 70% and 84% of nurses responded that education, literature and information technology, respectively, played a minor role in obtaining knowledge about pain management. Sixty-five percent of the respondents had basic skills for evaluating pain, although 54% could not evaluate the degree of pain. Almost 62% of nurses did not trust the pain experience self-reported by patients who were opioid abusers.

CONCLUSION

Our study shows shortcomings in the nurses' competence to evaluate and treat pain, suggesting that patients with opioid addiction may not receive adequate pain management. Nurses' competence to offer pain treatment to opioid abusers could be characterized as experience-based rather than evidence-based.