Student name

Capella University

NURS-FPX8004 

Professor Name

Submission Date

Annotated Bibliography

NURS FPX 8004 Assessment 3 Annotated Bibliography involves compiling scholarly sources with summaries and evaluations to support your DNP project research. Pain management is one of the most urgent problems in inpatient rehabilitation centers, with access to conservative measures being a factor that influences patient outcomes to a large extent. Inadequately managed pain is also a common feature in adults visiting the specialized facilities and is a barrier to engagement in critical therapeutic activities (Janevic et al., 2025). Nurses, physicians, patients, and administrative staff are some of the main stakeholders who are directly affected by current gaps in pain management guidelines. In nursing personnel working in inpatient rehabilitation facilities (P), what is the effect of an opt-out policy regarding conservative pain management protocols (I), versus existing practice (C), on response time to pain management (O) in 12 weeks (T)? The quality improvement plan will provide a higher therapeutic participation rate and result in better overall rehabilitation outcomes, as it will be possible to access the evidence-based pain management interventions promptly.

Search Strategy

A thorough review of the literature was done in various databases to find evidence-based interventions to manage pain in the rehabilitation area. Keywords, such as pain management, rehabilitation facilities, nonpharmacologic interventions, opioid reduction, collaborative care, and nursing interventions, were used to search the databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and PsycINFO. The use of Boolean operators incorporated search phrases like chronic pain AND rehabilitation, pain protocols AND nursing, and nonpharmacologic pain management AND inpatient. The first searches resulted in 247 articles in all databases. Peer-reviewed articles published between 2020 and 2025, adult populations in rehabilitation or healthcare facilities, and interventions related to pain management or opioid reduction were required as the inclusion criteria. Articles that were limited to acute care environments, the children population, or non-English articles were excluded. Eight articles were kept, which specifically covered pain management interventions, collaborative care models, and evidence-based approaches to be used in inpatient rehabilitation facilities, which offered a strong foundation as to the current best practices in conservative pain management approaches.

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 randomized controlled trial protocol. National Institute for Health and Care Research Open Research. https://doi.org/10.3310/nihropenres.13441.1

The authors presented the cluster randomized controlled trial of a primary care pharmacist-led intervention to decrease opioid use in persistent pain. The pragmatic trial design assigned 38 general practices in England to either the PROMPPT intervention or usual care. The intervention was a proactive clinical review of patients on long-term opioids undertaken by trained practice pharmacists who had related training packages. Reduction in self-reported opioid use and non-inferiority of pain interference scores at 12 months were the co-primary outcomes. The protocol has assisted in adding to the literature, as it has provided a framework to evaluate the pharmacist-led interventions in primary care practices, which is highly necessary to lessen inappropriate long-term opioid prescribing.

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 sought to identify the most suitable order of conservative treatment of Veterans with chronic low back pain. The pragmatic randomized trial recruited 2,529 participants using a dual-phase intervention protocol in 20 Veterans Affairs medical facilities using a stepped-care methodology. The first stage is the assignment of the participants into three treatment conditions, namely digital self-management programs, detailed physical therapy interventions, and regular care with systematic monitoring. Those who do not respond go to the second step, where they are given cognitive behavioral therapy, chiropractic manipulation, or yoga. The study has addressed a large knowledge gap in the literature, and has offered empirical data to support the sequencing of treatments in a structured way in conservative pain management, and has provided an outline of the implementation of the cost-effective, safety-based stepped-care models in a population of veterans with chronic musculoskeletal disorders.

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 provided an in-depth analysis of the short-term psychological interventions that would help reduce opioid prescriptions and related risks in people with persistent pain conditions. In this study, systematic review protocols were employed to search the literature over 40 years (1980-2020) in five databases that are academic and eventually identified six studies that qualified. Patient receptivity to abbreviated psychological treatments was assessed with a supplementary questionnaire that was administered to 188 people who currently use prescribed opioids. The results showed all six reviewed studies supported treatment efficacy in reducing opioid use or alleviating related adverse effects, but methodological rigor was typically not optimal in the studies. The research added to the evidence base as it revealed the large gap between patient interest in psychological treatments (92% expressed readiness to join in the interventions) and the lack of high-quality research to support these measures in the management of chronic pain.

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 presented a randomized controlled trial that evaluated a self-management intervention for chronic pain delivered by health workers in the community to older adults in less privileged urban communities. The single-site parallel-group superiority trial evaluated a group of 414 subjects aged 50 years or older and randomized them to the STEPS intervention or a control group of regular care. The STEPS intervention consists of seven weeks of pain management self-management videos, weekly phone calls with community health workers, activity monitoring, and social needs assessment with referrals to the community. Pain interference was used as a primary outcome measure, with secondary outcomes being pain intensity and global impression of change. The protocol assisted in contributing to the research of health equity because it considers structural obstacles to pain care access in vulnerable groups, especially the African American older adult population with several 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 detailed a multi-center pragmatic trial that studied the effectiveness of telehealth-provided team-based care on severe chronic pain among Veterans in the rural setting. The methodology of the controlled trial involved 608 individuals in four locations and randomly assigned them to the Tele-Collaborative Outreach to rural patients (CORPs) program or standard care with slight improvements. The CORPs program involved a multi-dimensional biopsychosocial assessment, systematic meetings with nursing care coordinators, expert physician consultations, and virtual pain management education in groups. The main outcome was discussed as pain-related functional interference, with planned evaluations of implementation mechanisms and economic results. The protocol assisted in resolving the rural healthcare access disparities by providing evidence-based structures for providing specialized pain management services to geographically isolated communities using 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 evaluated the feasibility and acceptability of a virtual collaborative pain management program (VCPM) for U.S. Veterans undergoing high-dose chronic opioid therapy. This uncontrolled feasibility study used to utilize a before-and-after design, whereby 133 patients were recruited in two Veterans Health Administration facilities. The VCPM intervention assists in the combination of medication reassessment with dose-tapering measures, buprenorphine switch-over protocols with continued oversight, and cognitive-behavioural self-management interventions delivered by clinical pharmacists. Results indicated that 84 percent of the veterans who attended multiple sessions were able to successfully switch to buprenorphine or experience opioid dose reductions, with a significant reduction in morphine equivalent daily dosing. The study assisted in providing important implementation science information in support of the feasibility of remote multidisciplinary pain management strategies in the event of a public health crisis, which creates a foundation in support of complex telehealth interventions in resource-scarce health settings.

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 assisted in testing the feasibility, as well as acceptability, of a screening, brief intervention, and referral to treatment model specifically aimed at managing pain (SBIRT-PM) among veterans with chronic pain as they seek disability benefits. The uncontrolled pilot study involved 40 veterans in eight medical centers around New England and provided up to four telephone-based counseling sessions that used motivational interviewing methods. The program provided educational information and assisted in the involvement in extensive pain management strategies to veterans who were already involved in two or fewer Veterans Affairs (VA) pain treatment options. Outcomes showed 80 per cent attendance in at least one counseling session, 90 per cent of the participants attended 12-week follow-up assessments and reported satisfaction with information about pain care resources and counselor support. The author provided evidence of the potential to adapt screening, brief intervention, and referral models to the specific pain management setting, which proved that motivational interviewing strategies could be used to enhance treatment adherence 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 investigated the possibility of an online pain self-management program to decrease the use of opioids in managing pain in adults under long-term opioid therapy. The study was an open-label, intent-to-treat, randomized clinical trial that recruited 402 participants in primary care and pain clinics of two academic healthcare systems. The participants were randomized into either the goalistics chronic pain management or the treatment-as-usual. Findings revealed that 53.6 percent of the intervention group experienced a 15 percent or more decrease in the number of morphine equivalent daily dose, as opposed to 42.3 percent of the control group. The research made a substantial contribution to the field of pain management through the objective findings that online self-management interventions can be used to achieve clinically significant opioid reduction of dose reduction and, at the same time, enhance pain outcomes.

Conclusion

The annotated bibliography combined existing evidence about pain management interventions in rehabilitation and healthcare contexts, and it has been shown that the focus remains on nonpharmacologic interventions and collaborative models of care. The literature reviewed shows a high level of support for interventions based on a combination of self-management education, telehealth delivery methods, and interdisciplinary team approaches to decrease opioid dependence and ensure adequate pain control. Evidence in the research indicates that short psychological interventions, programs delivered by community health workers, and pharmacist-led reviews can produce significant opioid-use reduction without affecting pain outcomes. The observations help to support the use of stepped-care models where conservative methods are given first and then move to intensive methods of treatment, which is in compliance with the existing clinical practice guidelines that focus on patient safety and evidence-based interventions.