[ANSWERED 2024] Patients frequently present with complaints of pain such as chronic back pain. They often seek medical care with the intent of receiving drugs to manage the pain

Written By: Dan Palmer, RN

Patients frequently present with complaints of pain such as chronic back pain. They often

Patients frequently present with complaints of pain such as chronic back pain. They often seek medical care with the intent of receiving drugs to manage the pain

Discussion: Chronic Back Pain

Patients frequently present with complaints of pain such as chronic back pain. They often seek medical care with the intent of receiving drugs to manage the pain. Typically, for this type of pain, narcotic drugs are often prescribed. This can pose challenges for you as the advanced practice nurse prescribing the drugs.
While there is a process for evaluating back pain, it can be difficult to assess the intensity of a patient’s pain because pain is a subjective experience.
Only the person experiencing the pain truly knows whether there is a need for drug treatments. This makes it important for you, as the prescriber, to watch for red flags and warning signs of abuse. In this Discussion, you explore the ethical implications of prescribing narcotics to patients with chronic back pain.
To prepare:
  • Review this week’s media presentation on evaluating back pain, as well as Chapter 15 of the Buttaro et al. text in the Learning Resources. Reflect on the evaluation process for a patient with a history of back pain.
  • Consider how you might evaluate a patient that presents with back pain. Think about potential red flags and warning signs of drug abuse.
  • Reflect on the ethical implications of prescribing narcotics for chronic back pain.
  • Think about what you would prescribe and why.

By Day 3

Post a description of how you might evaluate a patient who presents with back pain. Then, describe potential red flags and warning signs of drug abuse. Explain the ethical implications of prescribing narcotics for chronic back pain. Finally, explain what you would prescribe for patients and why.

Expert Answer and Explanation

Chronic Back Pain

Evaluating a Patient with Chronic Back Pain

An advanced practice nurse should evaluate patients who present with back pain accurately before prescribing them medications, such as narcotics. An APN can evaluate a patient with back pain using the following methods. Patel and Kinsella (2017) note that one of the methods of evaluating backpain is physical examination. The nurse should physically examine the patient to determine whether they suffer from back pain.

From the physical exam, a nurse group the patient into the following four categories.The categories include low back pain that is non-specific, back pain related to spinal stenosis or radiculopathy, back pain from a non-spinal source, and back pain linked to another cause of the spinal problem. Patel and Kinsella (2017) also note that the condition can be evaluated using computed tomography (CT) and magnetic resonance imaging (MRI).

Signs of Drug Abuse

APNs are responsible for identifying the signs of drug abuse in prescribing patients with medications. According to Geise and Powers (2020), physical warning signs and red flags of drug abuse include red eyes, tremors, dilated pupils, impaired physical coordination, rapid speech, lethargy during the day, and slowed speech.

The psychological warning signs of drug abuse the nurse should look at include anxiety, confusion, insomnia, depression, forgetfulness, excessive mood swings, illogical thinking, and memory loss. The APN should also analyze the patient’s behavior for warning signs of drug abuse.

These signs include erratic behavior, defensiveness or anger about drug abuse-related topics, poor social interaction, legal issues, poor judgment personality changes, violence, use of sleeping r headache drugs, and financial issues (Geise & Power, 2020). The nurse can also collect observations from friends and family. For instance, if the family reports that the patient has chronic relationship challenges, then the nurse should treat this information as a warning sign of drug abuse.

The Ethical Implications of Prescribing Narcotics

The first ethical implication of prescribing narcotic drugs to patients with chronic back pain is beneficence. According to Smeltzer et al. (2017), an APN should prescribe the narcotic drugs to patients after a prover and careful evaluation of the drugs’ impact in the patients. In other words, this consideration ensures that APNs prescribe narcotic medications that are more beneficial to the patient. Another consideration is non-maleficence.

This ethical consideration ensures that an APN considers other safe alternatives before deciding to prescribe narcotics as pain medication. Autonomy is another ethical consideration that has implications on the prescription of narcotic medication (2017). This consideration was designed to ensure that nurses allow patients to decide whether to take narcotics or not. In other words, the consideration forces the nurses to respect the wishes of their patients.

Treatment of Back Pain

I would not prescribe narcotics as drugs to relieve back pain because Coluzzi et al. (2019) note that medications with opioids, such as hydrocodone and oxycodone do not work well for severe and chronic pain. On that note, I can prescribe nonsteroidal anti-inflammatory drugs (NSAIDs). These over-the-counter medications can help relieve acute back pain. However, if the OTCs have no worked, I would prescribe Baclofen (Coluzzi et al., 2019). This drug is a muscle reluctant and can relieve pain by relaxing the muscles on the back.

References

Coluzzi, F., Polati, E., Freo, U., & Grilli, M. (2019). Tapentadol: an effective option for the treatment of back pain. Journal of pain research, 12, 1521. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526923/

Geise, R., & Powers, M. F. (2020). Roles of Pharmacy Technicians in Preventing Prescription Drug Abuse. Journal of Pharmacy Technology, 8755122520939640. https://doi.org/10.1177%2F8755122520939640

Patel, D. R., & Kinsella, E. (2017). Evaluation and management of lower back pain in young athletes. Translational pediatrics, 6(3), 225. doi: 10.21037/tp.2017.06.01

Smeltzer, K. E., Desai, G. J., & Johnson, B. (2017). Ethical Considerations in Prescribing or Withholding Opioids for Chronic Pain. Osteopathic Family Physician, 9(3). https://doi.org/-639-1-10-20170503.pdf

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Nurses’ Role in Pain Assessment and Management

As healthcare professionals, nurses play an essential role in assessing and managing patients’ pain. Pain is one of the most common symptoms that patients report, and its management is crucial for improving their quality of life. In this article, we will discuss the importance of pain assessment and management, the role of nurses in this process, and some strategies for effective pain management.

Importance of Pain Assessment and Management

Pain is a subjective experience that can be difficult to measure objectively. However, pain assessment is essential for effective pain management. Pain assessment allows healthcare professionals to understand the patient’s experience and the nature of their pain. It also helps to identify the underlying causes of pain, which can guide treatment decisions. Pain management is essential to prevent the development of chronic pain, reduce suffering, and improve the patient’s overall health outcomes.

Nurses’ Role in Pain Assessment and Management

Nurses play a vital role in pain assessment and management. They are often the first healthcare professionals to interact with patients, and they have the opportunity to assess and manage pain comprehensively. Nurses are responsible for identifying pain in patients, assessing its severity, and implementing appropriate pain management strategies. They also play a crucial role in educating patients and their families about pain management and its importance.

Identifying Pain in Patients

The first step in pain assessment is identifying pain in patients. Nurses must be vigilant in identifying pain and must take patients’ reports of pain seriously. Pain can manifest in many ways, such as verbal reports, facial expressions, body language, and changes in vital signs. Nurses must be aware of these signs and use them to identify pain accurately.

Assessing Pain Severity

Once pain has been identified, nurses must assess its severity. There are many tools available for assessing pain severity, such as numeric rating scales, visual analog scales, and verbal rating scales. Nurses must choose the appropriate tool for each patient and use it consistently to track changes in pain severity over time.

Implementing Pain Management Strategies

After pain has been assessed, nurses must implement appropriate pain management strategies. There are many strategies available for managing pain, such as pharmacological interventions, non-pharmacological interventions, and complementary therapies. Nurses must work with the patient and the healthcare team to develop a comprehensive pain management plan that addresses the underlying causes of pain and the patient’s individual needs.

Educating Patients and Their Families

Nurses must also educate patients and their families about pain management and its importance. Patients and their families must understand the nature of pain, the importance of pain assessment, and the available pain management strategies. They must also understand the risks and benefits of each strategy and their role in pain management.

Strategies for Effective Pain Management

Effective pain management requires a comprehensive, multidisciplinary approach that addresses the underlying causes of pain and the patient’s individual needs. There are many strategies available for managing pain, and healthcare professionals must choose the appropriate strategy for each patient. Some strategies for effective pain management include:

Pharmacological Interventions

Pharmacological interventions are the most common strategy for managing pain. They include non-opioid and opioid medications. Non-opioid medications include nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and adjuvant medications. Opioid medications include morphine, fentanyl, and oxycodone. Nurses must work with the healthcare team to choose the appropriate medication for each patient and monitor their effectiveness and side effects.
Non-Pharmacological Interventions

Non-pharmacological interventions include physical therapy, occupational therapy, and psychological interventions. Physical therapy and occupational therapy can help to improve mobility, reduce pain, and prevent the development of chronic pain. Psychological interventions, such as cognitive-behavioral therapy and mindfulness-based stress reduction, can help patients cope with pain and improve their overall well-being. Nurses must work with the healthcare team to incorporate non-pharmacological interventions into the patient’s pain management plan and monitor their effectiveness.

Which Substance Reduces the Transmission of Pain?

Pain is an unpleasant sensory and emotional experience that can be caused by a variety of factors, including injuries, diseases, and psychological disorders. Although pain is an essential protective mechanism that alerts us to potential danger and helps us avoid further injury, it can also be chronic and debilitating, significantly affecting our quality of life. Luckily, there are many ways to manage pain, including pharmacological and non-pharmacological interventions. One approach that has gained popularity in recent years is the use of substances that reduce the transmission of pain. In this article, we will explore the most common and effective substances used to alleviate pain and how they work.

Introduction to Pain Transmission

Before we delve into the substances that reduce pain transmission, let us first understand how pain is transmitted in the body. Pain signals are generated by specialized nerve cells called nociceptors, which are activated by harmful or potentially harmful stimuli, such as heat, pressure, or chemicals. Once activated, the nociceptors send electrical signals to the spinal cord and the brain, where they are interpreted as pain.
Endorphins
Endorphins are neurotransmitters that are produced by the pituitary gland and the hypothalamus in response to stress, exercise, and pain. Endorphins bind to specific receptors in the brain and spinal cord, blocking the transmission of pain signals and producing feelings of euphoria and well-being. Endorphins can be released naturally by engaging in activities such as exercise, meditation, and laughter. However, synthetic versions of endorphins, such as morphine and other opioid analgesics, are commonly used to manage pain in clinical settings.
Serotonin
Serotonin is a neurotransmitter that regulates mood, appetite, and sleep. However, it also plays a crucial role in pain management by inhibiting the release of substance P, a neuropeptide that is involved in pain transmission. Serotonin is released by specialized cells in the brainstem and the gut, and medications that increase serotonin levels, such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), have been shown to reduce chronic pain.
GABA
Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter that regulates neuronal excitability and reduces anxiety. GABA acts by binding to specific receptors in the brain and spinal cord, reducing the release of neurotransmitters that transmit pain signals. GABA agonists, such as gabapentin and pregabalin, are commonly used to manage chronic pain, particularly neuropathic pain.
Capsaicin
Capsaicin is a compound found in chili peppers that is responsible for their spicy taste. Capsaicin acts by binding to a specific receptor called the transient receptor potential vanilloid 1 (TRPV1), which is involved in pain transmission. Capsaicin initially causes a burning sensation, but repeated exposure to capsaicin can lead to desensitization of the TRPV1 receptor, reducing the transmission of pain signals. Capsaicin is commonly used as a topical analgesic for conditions such as arthritis and neuropathic pain.
CBD
Cannabidiol (CBD) is a non-psychoactive compound found in cannabis plants that has been shown to have analgesic and anti-inflammatory properties. CBD acts by binding to specific receptors in the brain and spinal cord, reducing the release of neurotransmitters that transmit pain signals and modulating the immune system. CBD is commonly used to manage chronic pain, particularly in conditions such as multiple sclerosis, fibromyalgia, and neuropathic pain.
Conclusion
In conclusion, pain is a complex and multifactorial phenomenon that can significantly impact our quality of life. While there are many approaches to pain management, including pharmacological and non-pharmacological interventions, substances that reduce the transmission of pain have gained increasing attention in recent years. Endorphins, serotonin, GABA, capsaicin, and CBD are some of the most common and effective substances used to alleviate pain.However, it is important to note that these substances should be used under the supervision of a healthcare professional and in combination with other pain management strategies. By understanding how pain is transmitted in the body and how these substances work, we can better manage pain and improve our overall well-being.

Why Pain Management is Crucial in Nursing Care?

As healthcare providers, nurses play a vital role in ensuring that patients are well taken care of and experience optimal healing outcomes. One of the most important aspects of patient care is pain management. Pain is a common experience for many patients, and when not properly managed, it can have significant negative consequences on patient outcomes, including delays in recovery, decreased quality of life, and increased healthcare costs.

Therefore, it is essential for nurses to prioritize pain management as part of their nursing care. In this article, we will explore why pain management is crucial in nursing and the importance of effective pain management for optimal patient outcomes.

What is Pain Management?

Pain management is a critical aspect of nursing care that involves the assessment, prevention, and treatment of pain. It is an interdisciplinary approach to treating pain that involves different healthcare professionals, including nurses, physicians, pharmacists, and physical therapists.

Pain management involves identifying the cause of pain, assessing the patient’s pain level, and selecting the most appropriate pain management strategy. Effective pain management is crucial in ensuring that patients experience optimal healing outcomes.

The Prevalence of Pain in Healthcare Settings

Pain is a common experience for many patients in healthcare settings. According to the American Society of Anesthesiologists, more than 100 million Americans suffer from chronic pain, with an estimated annual cost of $560-635 billion. Pain can be caused by various factors, including illness, injury, surgery, or medical procedures. Pain is also prevalent in older adults, with up to 50% of older adults experiencing chronic pain.

The Negative Impact of Uncontrolled Pain

Uncontrolled pain can have significant negative consequences on patient outcomes. It can lead to delayed recovery, decreased quality of life, and increased healthcare costs. Patients experiencing uncontrolled pain may also experience anxiety, depression, and sleep disturbances, which can further impact their healing outcomes. Therefore, it is crucial for healthcare providers, particularly nurses, to prioritize effective pain management.

The Role of Nurses in Pain Management

Nurses play a crucial role in pain management. As frontline healthcare providers, nurses are often the first point of contact for patients experiencing pain. Nurses are responsible for assessing the patient’s pain level, identifying the cause of pain, and selecting the most appropriate pain management strategy. Nurses also monitor the patient’s response to pain management interventions and make adjustments as necessary.

The Importance of Pain Assessment

Pain assessment is a critical component of effective pain management. It involves evaluating the patient’s pain level, location, and intensity. Pain assessment is essential in developing an effective pain management plan. Pain assessment tools, such as the Wong-Baker FACES Pain Rating Scale or the Numeric Rating Scale, can be used to assess the patient’s pain level accurately.

The Different Types of Pain Management Strategies

There are various pain management strategies that nurses can use to manage pain effectively. Pain management strategies can be divided into two broad categories: pharmacological interventions and non-pharmacological interventions.

Pharmacological Interventions

Pharmacological interventions are an essential component of pain management in nursing care. These interventions involve the use of medications to alleviate pain and improve the patient’s quality of life. The type of medication used depends on the cause and severity of pain.Analgesics are medications that are commonly used for pain management. These medications work by blocking pain signals from reaching the brain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, are examples of analgesics that can be used to manage mild to moderate pain.

Opioids are another class of medications used for pain management. These medications work by binding to specific receptors in the brain and spinal cord to block pain signals. Opioids are used to manage moderate to severe pain and are typically prescribed for short-term use due to the risk of addiction and other adverse effects.

Other medications used for pain management include antidepressants and anticonvulsants. These medications work by modifying the way the brain perceives pain signals and can be used to manage chronic pain.

It is crucial for nurses to monitor patients closely for adverse effects associated with pharmacological interventions, such as respiratory depression and sedation. Nurses should also educate patients about the potential side effects of medications and provide appropriate instructions on how to use them safely and effectively.

Non-pharmacological Interventions

Non-pharmacological interventions are another critical component of pain management in nursing care. These interventions involve the use of non-drug therapies to alleviate pain and improve the patient’s quality of life.One common non-pharmacological intervention is physical therapy. Physical therapy involves exercises and other techniques designed to improve mobility, strength, and flexibility. Physical therapy can be used to manage chronic pain associated with conditions such as arthritis or fibromyalgia.

Other non-pharmacological interventions include cognitive-behavioral therapy, relaxation techniques, and massage therapy. These interventions can be used to manage pain associated with stress, anxiety, and tension.

The Potential Complications of Pain Management

While pain management is essential in nursing care, it is not without its potential complications. Pharmacological interventions, in particular, can be associated with adverse effects such as addiction, respiratory depression, and sedation. Non-pharmacological interventions, such as physical therapy, can also result in adverse effects, such as muscle soreness and fatigue.

Therefore, it is crucial for nurses to monitor patients closely for adverse effects associated with pain management interventions and to provide appropriate education on how to manage these adverse effects effectively.

Strategies for Effective Pain Management

To ensure effective pain management in nursing care, nurses should prioritize the following strategies:

  • Conduct a thorough pain assessment to determine the cause and severity of pain
  • Develop an individualized pain management plan based on the patient’s needs and preferences
  • Educate patients about the potential side effects of pain management interventions
  • Monitor patients closely for adverse effects associated with pain management interventions
  • Provide appropriate education on how to use medications safely and effectively
  • Encourage patients to participate in non-pharmacological interventions, such as physical therapy and relaxation techniques
  • Evaluate the patient’s response to pain management interventions and make adjustments as necessary.

Barriers to Effective Pain Management

Despite the importance of effective pain management in nursing care, there are several barriers that can impede its implementation. One common barrier is a lack of education and training among nurses regarding pain management. Nurses may also face time constraints or inadequate staffing levels, which can limit their ability to provide effective pain management.

Other barriers to effective pain management include communication barriers between patients and healthcare providers, cultural differences, and the stigma associated with opioid use.

To overcome these barriers, it is crucial for healthcare organizations to prioritize pain management education and training for nurses, provide adequate staffing levels, and encourage open communication between patients and healthcare providers.

Conclusion

In conclusion, pain management is a critical component of nursing care. Effective pain management requires a comprehensive approach that involves both pharmacological and non-pharmacological interventions. Nurses play a crucial role in ensuring effective pain management by conducting thorough pain assessments, developing individualized pain management plans, and monitoring patients closely for adverse effects associated with pain management interventions.

However, there are several barriers to effective pain management, including a lack of education and training among nurses, time constraints, and communication barriers. To overcome these barriers, healthcare organizations must prioritize pain management education and training, provide adequate staffing levels, and encourage open communication between patients and healthcare providers.

By implementing effective pain management strategies, nurses can help improve the quality of life for patients experiencing pain and promote positive health outcomes. It is essential to remember that pain management is not just about treating the physical symptoms of pain but also about addressing the emotional, psychological, and social aspects of pain. With a comprehensive approach to pain management, nurses can provide holistic care that supports the overall well-being of their patients.

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