How to write a nursing essay on Lower Back Pain Case Study

How to write a nursing essay on Lower Back Pain Case Study

Year-Old Male With Lower Back Pain: What would you do first prior to prescribing any medication?

The first part will involve taking the patient’s history and conducting a physical examination. Obtaining baseline information about the patient’s pain and medications will guide the approach to prescribing opioid medications. The second part will involve the assessment of the patient for eligibility for opioid medication use and the establishment of goals. The Centers for Disease Control and Prevention (CDC) guidelines indicate that opioids should be prescribed when the potential benefits outweigh the risk. Before prescribing the drugs, I would perform a urine drug screen and administer the DAST-20 screening tool to ascertain if the patient has the potential for drug abuse (CDC, n.d.). If substance abuse is suspected, the patient may be required to sign a pain management agreement. The next step will involve establishing goals for pain and function including how the therapy will be discontinued. Lastly, I will discuss the risks and benefits of commencing opioid therapy and the possibility of discontinuing medication if the risks outweigh the benefits.

What are the various schedules of medications for controlled substances?

The Controlled Substance Act (CSA) divides controlled drug substances into five schedules.

Schedule I. Drugs under this category have no medical uses in the United States because of safety issues (Drug Enforcement Administration (DEA), 2021). Examples include lysergic acid diethylamide (LSD), marijuana, Ecstasy, and methaqualone.

Schedule II. Substances in this schedule have a high potential for abuse and may result in severe psychological or physical dependence (DEA, 2021). These drugs include hydromorphone (Dilaudid), methadone (Dolophine), meperidine (Demerol), oxycodone (OxyContin, Percocet), and fentanyl (Sublimaze, Duragesic). Others include drugs like morphine, codeine, opium, and hydrocodone. Some stimulants like amphetamine and methamphetamine also fall under this class.

Schedule III. Drugs under this category have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence (DEA, 2021). Examples include products containing more than 90mg of codeine per dosage unit, buprenorphine, benzphetamine, phendimetrazine, ketamine, and steroids like testosterone.

Schedule IV. Drugs under this category have a low potential for abuse relative to substances in Schedule III. Examples include alprazolam, carisoprodol, clonazepam, midazolam, lorazepam, and triazolam among many others.

Schedule V. Substances under this category have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics (DEA, 2021). They include drugs like ezogabine, and preparations containing less than 200mg of codeine per ml or per 100 gms like Robitussin.

Would you prescribe a long or short-acting narcotic? Why or why not?

I will prescribe a short-acting narcotic because they are preferred for transient pain like chronic intermittent pain that does not require long-lasting analgesia. When starting opioid therapy, it is recommended to start with immediate-release opioids and should be given at the lowest effective dosage (CDC, n.d.). Long-acting opioids stay in the bloodstream for prolonged periods and their use is most effective for patients with persistent chronic non-cancer pain that requires stable, around-the-clock dosing. Short-acting narcotics that may be of great use to the patient include drugs like morphine, fentanyl, codeine, and hydrocodone.

Discussion 2

What patient education is needed with them?

The first part should focus on the ability to develop addiction upon the use of opioid analgesics. The patient should be cautioned about this adverse effect and that routine monitoring for signs of addiction will be done to determine when opioids will be no longer needed. Secondly, the patient should be informed about the side effects of opioids that include constipation, drowsiness, and breathing difficulties that may result from drug overdose (Kadakia et al., 2020). The patient should take the medication as prescribed and immediately seek help if the side effects become overwhelming. The patient will also be advised on taking opioids with drugs like barbiturates, antihistamines, and alcohol that may increase the severity of respiratory depression (Kadakia et al., 2020).

What other non-narcotic medication options can you offer to this patient?

Howard explains that he cannot take analgesics like Motrin due to ulcers. Non-steroidal anti-inflammatory drugs will not be the best choice for this patient because they may increase the risk of bleeding. I will prescribe acetaminophen (Tylenol) for the management of the patient’s pain. This drug can be effective in the management of acute or persistent pain that is mild to moderate. A dosage of 650 mg of acetaminophen taken 4 to 6 hourly will be appropriate to manage severe pain. However, monitoring for hepatotoxicity and kidney problems should be done.

 

 

What would you do if the patient and his wife tell you that none of them work for him?

I will assess the patient’s compliance with pain medication before changing the course of treatment. Upon ascertaining the opioid and non-opioid medication provide little or no relief, I will order additional tests like x-ray, CT scan, and MRI to identify any serious causes of the problem. Additionally, further examination including performing tests like FABER and Lasegue’s sign can help to rule out abnormalities like caudal equina syndrome that can cause chronic back pain. If the tests reveal normal results, I would proceed to refer Howard to a pain specialist for exploration of other treatment options.

Discuss about narcotic addiction in USA

The misuse and addiction to opioids including prescription pain relievers is a serious national crisis in the US. The National Institute of Health (NIH) (2021) explains that narcotic pain killer addiction has increased by 400% over the last decade. Nearly 50,000 Americans lost their lives in 2019 due to opioid overdose and the total economic burden of prescription opioid misuse alone is $78.5 billion a year (NIH, 2021). Today, roughly 21 to 29% of patients prescribed opioids misuse them and about 12% of patients using these drugs develop an opioid use disorder (NIH, 2021). Heroin is the most abused opioid drug that accounts for more than 32.5% of all deaths resulting from narcotic misuse in the US (NIH, 2021). To address this challenge, the US Department of Health and Human Services together with NIH has put priorities on improving access to treatment and recovery centers. Additionally, promoting the use of overdose-reversing drugs, advancing better practices of pain management, and supporting cutting-edge research can help to address the opioid crisis in the country.

 

What Is pain tolerance? elaborate

Pain tolerance is the maximum amount of pain a person can withstand. Pain tolerance varies between individuals and is influenced by factors like experience, age, genetics, and sex (Cimpean & David, 2019). Increased pain tolerance is an important factor that helps patients to alleviate the suffering that comes with pain. Literature shows that lower levels of pain tolerance are associated with depression, frustration, reduced activity, and addiction to medication (Cimpean & David, 2019). Pain tolerance can be increased using strategies like association and disassociation. These strategies increase pain tolerance by enabling the individual to become more conditioned to pain.

 

 

References

Centers for Disease Control and Prevention. (n.d.). CDC guide for prescribing opioids for chronic pain: Promoting patient care and safety.

https://www.cdc.gov/drugoverdose/pdf/Guidelines_At-A-Glance-508.pdf

Cimpean, A., & David, D. (2019). The mechanisms of pain tolerance and pain-related anxiety in acute pain. Health Psychology Open, 6(2), 2055102919865161.

https://doi.org/10.1177/2055102919865161

Drug Enforcement Administration. (2021). Controlled substance schedules.

https://www.deadiversion.usdoj.gov/schedules/

National Institute of Health. (2021). Opioids: Opioid overdose crisis.

https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis

Kadakia, N. N., Rogers, R. L., Reed, J. B., Dark, E. R., & Plake, K. I. (2020). Patient education interventions for prescription opioids: A systematic review. Journal of the American Pharmacists Association : JAPhA, 60(4), e31–e42.

https://doi.org/10.1016/j.japh.2020.02.013

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