Academic journal article The Qualitative Report

The Magic Wand: A Case Study of Chronic Neck Pain

Academic journal article The Qualitative Report

The Magic Wand: A Case Study of Chronic Neck Pain

Article excerpt

Introduction

Chronic pain costs the US $635 billion annually which is more than the yearly costs for cancer, heart disease and diabetes (Gaskin & Richard, 2012). The incidence of self-reported neck pain in the general population is 213 per 1,000 persons (Hogg-Johnson et al., 2008). Pain is managed largely by pharmaceutical intervention. Pain medications, however, may have side effects including drug dependency, drug interaction, and adverse systemic reactions. While pharmaceutical intervention is considered "usual care" (Hurwitz et al., 2009; van der Velde et al., 2009), there is increasing concern about adverse effects (gastrointestinal, cardiovascular, mortality) of chronic analgesic use and polypharmacy (Adams et al., 2011; Caughey, Roughead, Pratt, Killer, & Gilbert, 2011; Reid et al., 2011; Roth & Anderson, 2011), and prescription drug abuse (Becker et al., 2009).

Sales of opioids, one of the most commonly prescribed pain relievers, increased fourfold between 1999 and 2010 (CDC, 2011). The substance abuse treatment admission rate in 2009 was almost six times the rate in 1999 (CDC, 2011). According to systematic review results (Morasco et al., 2011), 28%-42% of primary care and 15%-50% of outpatient pain clinic patients have history of substance use disorders. More deaths are attributed to prescribed painkillers than to cocaine and heroin combined or to motor vehicle accidents. In a study of persons using opioid analgesic prescriptions for a pain (Dunn et al., 2010) , the annual overdose rate was 256 per 100,000 person-years in patients who recently received medically prescribed opioids compared with 36 per 100,000 person-years in the subsample who did not. Painkiller deaths have increased by 300% since 1999 (CDC, 2011). In spite of the widespread use of opioids, opioid medications may result in as much as a 30% reduction in pain for only half of the patients who use them (Bloodworth, 2006).

In addition to pharmaceutical interventions, surgeries (fusion, disc replacement), regional anesthetic interventions such as steroid injections, rehabilitative/physical therapy and complementary and alternative medicine treatment modalities are used to relieve and/or manage pain (IOM, 2011). Invasive and expensive surgeries are considered a last resort. No strong evidence to support anesthetic injection therapy has been found except for some specific types of patients (Luijsterburg et al., 2007; Staal, de Bie, de Vet, Hildebrandt, & Nelemans, 2008). Rehabilitation/physical therapy has been found to reduce pain intensity and use of pain medications (Hoffman, Papas, Chatkoff, & Kerns, 2007) Nearly half of people with pain seek help from complementary and alternative medicine practitioners (Wells, Phillips, Schachter, & McCarthy, 2010).

The focus of this case study is to use Interpretative Phenomenology Analysis (IPA; Smith, Flowers, & Larkin, 2009) to understand the journey from pharmaceutical to alternative care for one patient with chronic neck pain. A study (Scherer, Schaefer, Blozik, Chenot, & Himmel, 2010) of how patients experience neck pain, their impression of different therapies, and the expectations they bring to physician- offices, and. found that participants preferred self-care (measures (analgesics while voicing concern about toxic, addictive, gastric side effects), exercising, relaxation, heat packs, warm showers, and electrical stimulation) and sought physician care only when self-care measures failed. Physician visits were seen as an extension of self-help, i.e., when self-help was no longer effective, patients sought prescriptions for massage, physiotherapy, and/or local anesthetic injections. Most subjects reported experiences with therapies such as physiotherapy, massage, injections, and acupuncture but complained about their inefficiency. The terms massage and physiotherapy were used interchangeably by participants who reported that massage was effective for temporary relief. …

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