Date of Conferral



Doctor of Nursing Practice (DNP)




Patrick Palmieri


Opioid therapy is widely used to treat veterans with chronic noncancer pain (CNCP) despite evidence indicating patient safety concerns with the treatment. Although there is a place for opioid therapy in chronic pain management, opioids are not recommended as the first line of treatment for CNCP because of the risk for accidental overdose and death. The purpose of this project was to examine alternative practices for managing CNCP through a systematic review of the literature guided by the conceptual model of the Joanna Briggs Institute method for systematic reviews (JBIM-SR). A critical appraisal of the literature was conducted, and data were extracted and analyzed to identify evidence-based alternatives to opioids for managing CNCP in veterans. Using Cochrane, CINAHL, Joanna Briggs, and PubMed databases for the search, 116 articles were initially identified and through exclusion of duplicates and those not consistent with the study purpose, the review was narrowed to 16 articles. A 2nd reviewer completed an identical search using the exclusion criteria and databases confirming the search results of the primary reviewer. The 16 peer-reviewed research studies published between 2006 and 2016 selected for the analysis were graded using the JBIM-SR grading chart. Educational programs were seen as positive for improving providers' use of alternative therapies for CNCP. Complementary and alternative therapies such as yoga, peer support, injection therapy, cognitive behavioral therapy and acceptance commitment therapy provided improvement in pain perceptions, and coping abilities. Results of this project can promote positive social change as the findings are shared with providers in the practice site and as Veterans receive safe alternatives to opioid therapy.