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Jordan Collins

Dr. Guenzel

ENC 1102-0203

October 15, 2018

Research Dossier

I was motivated to research pain management, the problems associated, and possible

solutions for two reasons. The first is my struggle with chronic pain and trying to reduce and

manage it. The second is a discussion I had with a pharmacy student about the cycle of addiction

that can occur when using medications, such as opioids and methadone, to manage pain. I am

very motivated and driven to do this research; however, that seems to be my biggest problem or

roadblock that I have encountered. My motivation is my roadblock because of it partially

stemming from my battle with chronic pain and the bias that I possess towards alternative

medical treatments, specifically physical therapy. I have used medications to manage my pain;

however, they either made me sick or did not lessen my pain, making my only solution physical

therapy. My pain itself is also a roadblock because it prevents me from sitting, standing or laying

down for prolonged periods so I’ll often have to break my focus to get up and move around or

stretch and will have to restart my train of thought. I hope to find a maintainable solution, that

will work for everyone who is suffering through chronic pain and doesn’t want to risk addiction

or finds prescription medication to be ineffective in managing pain.

This addiction to medications used is a problem that needs to be addressed and a solution

needs to be found, because of the sheer number of people affected by chronic pain. While

opioids and methadone can effectively reduce pain, it is typically only temporary and, often leads

to addiction. However, opioids and methadone are not the only solutions for chronic pain
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sufferers. There are new pharmaceutical developments that reduce the methods of abuse, and

there are many types of alternative medicines that don’t involve medication at all. These methods

lower addiction rates and prevent addiction, respectively. This research will identify the current

issue with pain management, addiction, and give alternative ways to manage pain, that lessen or

eliminate prescription drug dependencies.

To better understand how pain management developed into what it is now, background

on the history of pain management is needed. Collier, Olson, the interview conducted with Ms.

Bowling, and Sabatowski, Schäfer, Kasper, Brunsch and Radbruch provide information about

the development of pain management, and the medication and treatments that have been used.

The claim that pain management with prescription medication is flawed is shown to be true in

Fudin, “How Opioid Addiction Occurs,” “Opioid Overdose,” Richards, and “Chronic pain:

Medication decisions,” which all provide evidence of the issue of addition and how serious it is

becoming. In the interview with Ms. Bowling, the problem of addiction in pain management is

also addressed, and she lists various prescription medications by name. “Drugs A-Z List” allows

for those medications mentioned to be searched and information about the chemicals contained

in them, the dosage, side effects, warnings, and overdosage can be attained.

To understand the best solution for chronic pain chronic pain itself must first be

understood. “Chronic Pain: In Depth” defines and explains chronic pain, as well as giving

statistics on how chronic pain affects people and introducing alternative treatments to aid in

reducing chronic pain. The solution to addiction in pain management treatment, while it may

seem to be simple, is quite elaborate. Many - like Coronado and Bialosky, and “Physical Therapy

for Chronic Pain Is Proven to Be Highly Effective” - claim that physical therapy should be used

to treat, even cure, chronic pain that patients suffer. Others, such as Tennant, “Chronic pain:
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Medication decisions,” and Olson, claim that non-opioid medications such as anti-depressants

and muscle relaxants could be used when treating chronic pain sufferers. And some, such as

Torborg, Coronado and Bialosky, and “Physical Therapy for Chronic Pain,” propose many

options for chronic pain treatment, allowing the patient to pick the option they feel suits them

best.

Research Map

Research Questions:

What prescribe drugs at pain management facilities are the most addictive?

What is prescribed to prevent addiction, and how does it work?

What pharmaceutical advances are being made to prevent addiction?

What types of alternative medicine can take the place of prescription drugs to aid in pain

management?

Keywords:

 Addictive prescription drugs

 Pain management history

 Ways to manage pain

 Alternative medicine

 Pain management

Types of Evidence:

 Library: 2 sources

 Internet: 12 sources

 Field: 1 source
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Research schedule:

Red = Composition 2 Green = Calculus 2 Purple = Philosophy Blue = Intro to C

Yellow = Meetings Orange = Honors Symposium Research Days = * Drafting = “”
Going Home = ! Completed
October
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
30 1 2* 3 4* 5 6*!
Week 7 due Research RR 10 Blog Post HW 5 CKI
Church Map due Math Quiz IMO Health Baking Volunteering
IMO GBM Circle K Training Cake Party

7! 8 9* 10 11* 12 13*
Week 8 due Digital RR 14 Blog Post
Church Paper Trail FP 3 due IMO Health
Math Exam Circle K Training
Writing Lab
ACM-W
IMO GBM
14 15 16* 17 18* 19 20*
Week 9 due Research Outline Ethics Peer-Review Blog Post Exam 2 Plan CKI
Church Dossier paper Workshop 1 Math Quiz Applied Fundraiser
IMO GBM Writing Lab IMO Health Ethics
Circle K Training Paper Due
Plan CKI
Fundraiser
21 22 “23” “24” “25” “26”! 27!
Week 10 due RR 15 Plan CKI Final Draft Blog Post Community CKI
Church ACM-W Fundraiser Research Math Exam Service due Volunteering
IMP GBM Dossier IMO Health Possible
RR 16 Training Meeting
Circle K about IMO
Fundraiser
Halloween
Party
28 29 30 31
Week 11 due RR 17 (Peer-review RR 18
Church IMO GBM w/ Skylar) Circle K
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November
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
1 2 “3”
Blog Post
IMO Health
Training
4 5 “6” 7 8 “9” “10”
Week RR 19 Rhetorical Blog Post PRW 2
12 due ACM-W Analysis Math Quiz
Church IMO GBM Draft IMO Health
FP 4 due Training
Circle K
“11” 12 “13” 14 15 16 “17”
Church Pitch Ted Final Draft Blog Post Final Project Day
Talk Rhetorical IMO Health
IMO GBM Analysis Training
Circle K
18 19 “20” 21! 22! 23! 24!
Week RP Draft 1 PRW – Draft Blog Post
14 due Math Exam 1 RP THANKSGIVING
Church ACM-W Circle K
IMP GBM
“25”! “26” “27” “28” 29 30
Church RP Draft 2 RP Draft 3 IMO Health Extra Credit
Presentations Self- Training Final Draft
IMO GBM assessment PRW – Draft 3 RP
Draft Self-assessment
Presentations Presentations
Circle K Philosophy
Journals

December
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
1
Last Day of
Classes
2 3 4 5 6 7 8
Final Exam Ted-Talks/ Final Exam Final Exam
E-Portfolio Post Tests
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9 10 11 12 13 14 15
Going
Home

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

Annotated Bibliography
Chronic Pain: In Depth. (2018, September 12). Retrieved October 8, 2018, from
https://nccih.nih.gov/health/pain/chronic.htm
Content: This article offers a definition of what chronic pain is and discusses
statistics about how it effects people. Alternative treatments for pain, which the
article calls complementary health approaches, are explained and discussed for
multiple types of chronic pain. The research about the safety and side effects of
complementary health approaches are also summarized and discussed, as well as
what actions should be taken when considering complementary health approaches.
Author: This article was published by the National Center for Complementary and
Integrative Health, an organization that is committed to working with federal and
state partners to address the opioid crisis. The organization’s mission is to use
scientific investigation to define how useful and safe complementary health
approaches and the role they play in the improvement of health and health care.
Use: This article has a bias towards the use of alternative treatments for chronic pain
instead of using prescription medications, such as opioids. The organization the
published the article is addressing alternative medical practices as solutions with the
goal of lessening, even ending, the use of opioids and opioid based prescription
medications.
Chronic pain: Medication decisions (2018, February 14). Retrieved October 8, 2018, from
https://www.mayoclinic.org/chronic-pain-medication-decisions/art-20360371
Content: This article gives a list of the types of medications that can be taken for
pain management. Information about those medication mentioned is given. This
information includes: brand names, how the medication works, benefits and risks for
each medication, and a summary of all the information provided.
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Author: This article was published by the Mayo Clinic. “Mayo Clinic experts are some of
the best in the world. In the U.S. News & World Report rankings of top hospitals, Mayo
Clinic is consistently ranked among the top hospitals in the nation.”
Use: This article provides background of medication for pain management. The
information provided can be used when giving details and background on
medications used in pain management
Collier, R. (2018, January 08). A short history of pain management. Retrieved September 19,
2018,
Content: This article gives a brief history of pain management. The opioid crisis is
addressed and discusses why opioids where relied on so heavily. The history begins with
medicine from the early1600s, and discusses what patients were given to treat pain
throughout history. The problems with managing pain and the complexity of pain, and
the developing of understanding it are also addressed and discussed.
Author: Roger Collier is a medical journalist for the CMAJ. He has a bachelor’s degree in
electrical engineering and is both and an electrical engineer and a writer. He worked as a
columnist/reporter for Ottawa Citizen; then as a freelance writer writing pieces about
health, science, technology, and more; and is now an editor/reporter for CMAJ. At CMAJ
he researches and writes about health topics, interviewing experts.
Use: This article contains background information on the history of treating pain. The
information provided about what patients were given to treat pain and the history of
opioids and the opioid crisis can be used as background for the development of pain
treatments.
Coronado, R. A., & Bialosky, J. E. (2017, July 12). Manual physical therapy for chronic
pain: The complex whole is greater than the sum of its parts. Retrieved October 8, 2018,
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498791/
Content: In this article physical therapy as a treatment for chronic pain is discussed.
Chronic pain in the United States is an issue that is afflicting much of the population.
The pharmacology approaches that are used in pain management are addressed but
non-pharmacological treatments are the focus. The focus of the article is on the
benefits and personalization of physical therapy.
Author: Rogelio A. Coronado works in the Department of Physical Therapy, The
University of Texas Medical Branch, Galveston, TX, USA. Joel E. Bialosky works
in the Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
They have written multiple article relating to pain and treating pain with exercise
and physical therapy.
Bias: This article is biased towards the use of physical therapy in the treatment of
pain over the use of medications. The information can be used to explain the benefits
of the use of physical therapy over prescription medications.
Drugs A-Z List - A on RxList. (n.d.). Retrieved September 19, 2018, from
https://www.rxlist.com/drugs/alpha_a.htm
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Content: The text is a list of all pharmaceutical drugs. Each drug listed has a description
of the chemicals in the medication, dosage information and indications, side effects,
warnings, overdosage, and patient information.
Author: The information that is given on RxList is that which would be given by a doctor
prescribing the medications. All the information is taken from FDA publications about
the medications or the Multum drug database.
Use: This article can be used as evidence about the prescription medications that are used
in pain management facilities and their addictive behaviors.
Fudin, J. (2015, January 26). Abuse-Deterrent Opioid Formulations: Purpose, Practicality, and
Paradigms. Retrieved October 14, 2018, from
https://www.pharmacytimes.com/contributor/jeffrey-fudin/2015/01/abuse-deterrent-opioid-
formulations-purpose-practicality-and-paradigms
Content: The article discusses the rising numbers of deaths related to prescription
opioids. Extended-release (ER) opioid abuse is discussed and the ways of manipulating
these are mentioned. Legislation attempts have been made in response to the opioid
epidemic and the FDA has made regulations more restrictive. The purpose of abuse
deterrents, their effectiveness, and their variety are discussed. The article also discusses
specific abuse deterrents that are currently in use.
Author: “Dr. Jeff Fudin graduated from Albany College of Pharmacy & Health Sciences
with a BS and PharmD. He is a Diplomate to the Academy of Integrative Pain
Management, a Fellow to ACCP and ASHP, and a member of several other professional
organizations. He is President and Director, Scientific and Clinical Affairs for
Remitigate, LLC (remitigate.com), a software platform for interpreting urine drug screens
(Urintel) and risk for opioid-induced respiratory depression (Naloxotel). Dr. Fudin is a
section editor for Pain Medicine and serves on the editorial board for Practical Pain
Management. He practices as a clinical pharmacy specialist (WOC) and director of PGY-
2 pharmacy pain residency programs at the Stratton Veterans Administration Medical
Center in Albany, New York and has academic affiliations with Western New England
University and Albany Colleges of Pharmacy.”
Use: This article can be used to provide background for abuse deterrent formulas.
Excerpts can be used to explain what abuse deterrents are and how they work, as well as
why they are more effective than other medications and put patients at lower risk for
addiction.
How Opioid Addiction Ocurrs (2018, February 16). Retrieved September 19, 2018, from
https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-
opioid-addiction-occurs/art-20360372
Content: According to this article, anyone taking opioids is at of developing an
addiction. However, there are various factors that affect the patient’s vulnerability to
addiction. There are different effects of opioids based on how long they are being
taken. Becoming addicted and the rate of addiction are based on many opioid
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addiction risk factors that are discussed. But steps to prevent addiction are provided
to aid patients in lower their risk of addiction.
Author: This article was published by the Mayo Clinic. “Mayo Clinic experts are some of
the best in the world. In the U.S. News & World Report rankings of top hospitals, Mayo
Clinic is consistently ranked among the top hospitals in the nation.”
Use: This article can be used as an argument to engage when discussing the addictiveness
and negative effects of taking opioids or medication containing opioids.
Olson, K. A. (2015, May 19). History of Pain: The Treatment of Pain. Retrieved September 19,
2018, from https://www.practicalpainmanagement.com/treatments/pharmacological/history-
pain-treatment-pain?page=0,1
Content: “This is the fifth installment in Dr. Olson’s series on the History of Pain. The
first four installments addressed early pioneers in pain management, the nature of pain,
and the psychosocial assessment of pain. This issue will review, in a broad stroke, all the
elements of successful pain management programs—medical management, interventions,
and psychosocial coping strategies.”
Author: “Dr. Olson earned his doctorate from the University of Wyoming. His Internship
was at the University of Oregon Medical School, Department of Medical Psychology. He
continued his studies in the area of biofeedback at the Professional School of
Biofeedback in San Francisco, California, and at the Albert Einstein College of Medicine
in New York City. At the University of Texas, Dr. Olson studied neuropsychology
assessment. Dr. Olson has worked as a Staff Psychologist of Mental Health Programs, in
private practice, as Director of Behavioral Medicine and Psychological Services, and as a
psychologist in a Pain Management Center. He is a member of the American
Psychological Association, Association for Advancement of Behavior Therapy, Society
of Behavioral Medicine, and the Association for Applied Psychophysiology and
Biofeedback. Specific societies associated with the research of pain of which Dr. Olson is
a member of are the American Pain Society, Western Pain Society, International
Association for the Study of Pain, Neuromodulation Society, and Portland Pain Interest
Study Group. Dr. Olson has published more than 10 journal publications, written invited
monographs, and has an active history of invited lectureships. And his latest book is It
Hurts: A Practical Guide for Pain Management (WellBridge Books, 2018).”
Use: This article provides background on the history of opioid, acupuncture and injects,
and electrical stimulation in the treatment of pain. Excerpts can be used when giving
background on the history of treating and managing pain.
Opioid Overdose. (2017, August 30). Retrieved October 8, 2018, from
https://www.cdc.gov/drugoverdose/data/prescribing.html
Content: This publication is graphics and small descriptions of the graphics. These
graphics cover prescribing practices of opioids and medications containing opioids,
overdose deaths caused by opioids and methadone, an overdose map from 2015 to
2016, and an Urbanicity map from 2015 to 2016. An evaluation of prescription
guidelines in also included.
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Author: This publication was published by the Center for Disease Control (CDC).
The CDC is the health protection agency of the United States, the organizations goal
is to save lives and protect the nation from health, safety, and security threats.
Use: This publication will be used as an exhibit, containing evidence to analyze and
examine. The graphics can be used when discussing issue with prescribing practices
and overdoses.
Bowling, A. R. (2018, October 11). Pain Management and Addiction [E-mail interview].
Content: Ms. Bowling responds to questions about the pain management and the
problems that may be associate, if any. She also provides examples of addictive
medications that are used in pain management, medications that are intended to reduce
the risk of and ability to abuse. Ways that addicts abuse medications are discussed and
the more addictive medications are identified. She explains the difference between abuse
deterrent formulas and extended release medication, and problems associated with them.
And she discusses what she believes is the most effect way to treat chronic pain.
Author: This interview was conducted with Anna Bowling, a Doctorate of Pharmacy
Candidate. She is a pharmacy technician and full-time student at the Belmont College of
Pharmacy, expected to graduate in 2021. The information she gives in response to the
question is what she’s learned in classes and through discussion with professors and the
pharmacists she works under.
Use: By using this article, the perspective of a pharmacy student is given, as well as the
perspective of a pharmacy technician. The information given can be used as evidence of
issues with pain management and pharmaceutical advances that may aid in preventing
abuse.
Physical Therapy for Chronic Pain Is Proven to Be Highly Effective. (n.d.). Retrieved
October 8, 2018, from https://lasvegasrecovery.com/pain/chronic-pain-therapy/physical-
therapy-for-chronic-pain/
Content: Discusses the effectiveness of physical therapy in treating chronic pain and
the evidence that supports this. There is a wide range of issues that physical
therapists can aid with and how different combinations should be used for different
patients to effectively use physical therapy to reduce pain.
Author: This article was published by the Las Vegas Recovery Center. The LVRC
uses physical therapy because their philosophy is focused on recovery, not
management of pain.
Bias: This article is biased towards the use of physical therapy in the treatment of
chronic pain because the recovery center only uses physical therapy in their
treatments. Excerpts can be used to support the argument for the use of physical
therapy when treating chronic pain instead of using prescription medications that can
lead to addiction.
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Richards, P. (2018, September 10). 2018 Prescription Drug Abuse Statistics You Need To Know.
Retrieved September 10, 2018, from https://talbottcampus.com/prescription-drug-abuse-
statistics/
Content: The definition of addiction is given, and the growth of prescription drug
abuse rates are discussed. Statistics about the current prescription drug epidemic in
the United States, the prescription painkiller and opioid crisis, and teen prescription
drug abuse are provided. Signs of addiction are also given to help people realize if
themselves or their loved ones are dealing with addiction.
Author: This article was published by Talbott Recovery, an addiction recovery
center. “Talbott Recovery is dedicated to providing compassionate, comprehensive
treatment for co-occurring addiction and mental health disorders. Everything [done]
is aimed at helping people to find healing and develop the tools needed to maintain
long-term recovery. At Talbott, [offers include] an array of services to meet each
person's unique needs. This includes everything from assessment and detox to
Intensive Outpatient and Partial Hospitalization Programs. Each level of care
addresses the needs of the patient at a different stage in the treatment process, and
[the] team of professionals can help determine what's right for [each person].”
Use: This article provides information on addiction to prescription pain medications
from the recovery perspective. Excerpts can be used to discuss the harmful effects of
prescription pain medication addiction on addicts and their families and to show the
increasing number of individuals addicted to prescription medications.
Sabatowski, Rainer & Schäfer, Daniel & Kasper, Mario & Brunsch, H & Radbruch, Lukas.
(2004). Pain Treatment: A Historical Overview. Current pharmaceutical design. Retrieved
September 19, 2018.
Content: “Pain is a common experience of mankind. Pain theories and the management of
pain have been modified throughout the history of mankind. This article gives a brief
review on pain, pain believes and pain management from early magico-demonic and
magico-religeous ideas and procedures to more empiric-scientific models; from ancient
times and primitive cultures to the 20th century. Due to new anatomical, physiological
and biochemical insights, modern pain theories developed in the 19th and 20th century.
Modern analgesics were synthesized and new invasive procedures were approved having
a major impact on pain management strategies. However, older traditional beliefs and
attitudes have not been replaced completely and have survived to some degree in modern
patients.”
Author: Author Rainer Sabatowski is a professor at the Universitätsklinikum Dresden
(University Hospital Dresden) and is involved in research about pain therapy and chronic
pain. Author Daniel Schäfer is a professor at the University of Cologne working in the
Institute of Medical History and Medical Ethics and is involved in researching the history
of pain. Author Mario Kasper is also a professor at the University of Cologne, working in
the Division of Anesthesiology and is involved in researching different medications and
how they affect different conditions. Author Lukas Radbruch is a professor at the
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University of Bonn working in the Clinic and Polyclinic for Palliative Medicine and is
involved in researching controlled substances for medical and scientific purposes.
Use: This article provides a background on the history of treating pain. Excerpts from it
will provide the background necessary to understand how treating pain developed to what
it is today and what they developed from.
Tennant, F. (2018, May 1). Medications for Chronic Pain. Retrieved October 8, 2018, from
https://www.practicalpainmanagement.com/patient/treatments/medications/medications-
chronic-pain
Content: Non-opioid medications for pain management are listed: Non-steroidal
Anti-inflammatory Drugs, anti-depressants, anti-seizure medication, corticosteroids,
muscle relaxants, topical medications. And a description of each, including side
effects, what each treat, and occasionally they class or category the drug belongs to.
Author: “Forest Tennant, MD, DrPH, is an internist and addictionologist who
specializes in the research and treatment of intractable pain at the Veract Intractable
Pain Clinics in West Covina, California. Dr. Tennant started his pain clinic in 1975,
originally focused on treating the pain of cancer and post-polio disease. He has
authored over 300 scientific articles and books. Dr. Tennant is a member of the
American Academy of Pain Medicine, the Academy of Integrative Pain
Management, the American Pain Society, and the American Society of Addiction
Medicine. He formerly served as a Medical Officer in the US Army and US Public
Health Service, and was a consultant to the US Food and Drug Administration,
National Institute on Drug Abuse, Drug Enforcement Administration, LA Dodgers,
National Football League, and NASCAR.”
Use: This article can be used as an argument to engage when discussing pharmaceutical
treatments for chronic pain that don’t contain opioids and have a lower risk or no risk of
addiction.
Torborg, L. (2017, January 14). Mayo Clinic Q and A: Alternative treatments for chronic pain.
Retrieved October 8, 2018, from https://newsnetwork.mayoclinic.org/discussion/mayo-
clinic-q-and-a-alternative-treatments-for-chronic-pain/
Content: This article is in a question and answer format, in response to a patient asking
about ways to treat chronic pain without the use of medication. There are many
alternatives to medication when trying to treat chronic pain, a common problem. Some
solutions are more severe than other like surgery, while others are as simple as physical
therapy. These alternative treatments are mentioned and briefly explained.
Author: This article was published by the Mayo Clinic. “Mayo Clinic experts are some of
the best in the world. In the U.S. News & World Report rankings of top hospitals, Mayo
Clinic is consistently ranked among the top hospitals in the nation.”
Use: This article can be used as an argument to engage when discussing non-
pharmaceutical treatments for chronic pain, providing examples of treatments other than
medication.