Discussion: Chronic Back Pain
- 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
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.
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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