Posted: May 31st, 2023

Chronic Back Pain

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.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3
Post on or before Day 3 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.

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As an advanced practice nurse evaluating a patient presenting with back pain, I would follow a systematic approach to assess the patient’s condition and determine the appropriate treatment plan. Here is how I might evaluate a patient with back pain:

Patient History: I would begin by obtaining a detailed history, including the onset and duration of the pain, any precipitating factors, previous treatments, and the impact of pain on the patient’s daily life. This information helps to establish a baseline and identify any underlying conditions contributing to the back pain.

Physical Examination: I would conduct a thorough physical examination, assessing the patient’s range of motion, muscle strength, reflexes, and any signs of nerve involvement. This examination helps to identify any physical abnormalities or red flags that may require further investigation or referral to a specialist.

Diagnostic Tests: Depending on the findings from the history and physical examination, I may order diagnostic tests such as X-rays, MRI, or CT scans to assess the structural integrity of the spine and identify any underlying pathology or abnormalities.

Pain Assessment: Since pain is subjective, I would use validated pain assessment tools, such as the Visual Analog Scale (VAS) or Numeric Rating Scale (NRS), to measure the intensity and impact of the pain on the patient’s daily life. This helps in monitoring the effectiveness of treatment and making appropriate adjustments.

When evaluating a patient with back pain, there are potential red flags and warning signs of drug abuse that I need to be vigilant about. These include:

Frequent requests for early refills or lost prescriptions: Patients who repeatedly request early refills or report lost prescriptions may be displaying behaviors indicative of drug-seeking rather than genuine pain management.

Seeking medications from multiple healthcare providers: Patients who visit multiple healthcare providers in search of prescriptions for narcotics may be engaging in “doctor shopping” to obtain drugs for non-medical purposes.

Inconsistent or exaggerated pain symptoms: Patients who provide inconsistent or exaggerated descriptions of pain symptoms, especially with vague anatomical or physiological correlations, may be trying to manipulate healthcare professionals into prescribing narcotics.

History of substance abuse: Patients with a documented history of substance abuse, particularly opioids or illicit drugs, may be at a higher risk of abusing prescribed narcotics.

Prescribing narcotics for chronic back pain poses several ethical implications. While these medications can provide effective pain relief, they also carry risks of dependence, addiction, and adverse effects. It is crucial to balance the benefits of pain relief against the potential risks and carefully consider the following ethical considerations:

Beneficence and Non-Maleficence: As healthcare providers, we have a duty to provide the best possible care for our patients, which includes managing their pain. However, we must also prioritize patient safety and avoid causing harm. Prescribing narcotics requires a careful assessment of the benefits and risks to ensure the best possible outcome.

Autonomy: Patients have the right to make informed decisions about their healthcare. It is essential to involve patients in the decision-making process, educate them about the risks and benefits of narcotics, and explore alternative treatment options. Respect for autonomy means considering the patient’s preferences and values while adhering to the principles of safe prescribing.

Justice: The equitable distribution of healthcare resources is essential. While narcotics can be an effective treatment for some patients with chronic back pain, they may not be appropriate or necessary for everyone. It is important to consider individual patient characteristics, including the severity and impact of pain, functional limitations, and the potential for non-opioid treatments.

Based on the evaluation and assessment of the patient’s condition, I would prescribe a multimodal approach to managing chronic back pain. This may include:

Non-Pharmacological Interventions: I would recommend non-pharmacological interventions such as physical therapy, chiropractic care.
In addition to physical therapy and chiropractic care, other non-pharmacological interventions that can be beneficial for chronic back pain include:

Exercise and Rehabilitation: Encouraging the patient to engage in regular exercise, including strengthening and stretching exercises, can help improve muscle strength, flexibility, and overall spinal stability. This may involve a tailored exercise program or referral to a physical therapist.

Cognitive-Behavioral Therapy (CBT): CBT techniques can help patients develop coping strategies, manage pain-related distress, and modify maladaptive beliefs and behaviors associated with chronic pain. CBT can be an effective adjunct to pain management and improve overall functioning.

Heat/Cold Therapy: Applying heat or cold to the affected area can provide temporary pain relief and reduce inflammation. Heat therapy may help relax muscles, while cold therapy can numb the area and reduce swelling.

Acupuncture or Massage: Alternative therapies such as acupuncture or therapeutic massage may offer pain relief by targeting specific trigger points, promoting relaxation, and improving blood circulation.

When considering pharmacological interventions, it is important to weigh the risks and benefits, taking into account the individual patient’s circumstances. Non-opioid analgesics, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can be considered as first-line options for mild to moderate pain. These medications can help reduce pain and inflammation without the risks associated with opioids.

If the patient’s pain is severe or significantly impacting their daily functioning, opioids may be considered, but only after careful evaluation and consideration of the risks. In such cases, I would prescribe opioids judiciously and in accordance with current guidelines, utilizing the lowest effective dose for the shortest duration possible.

It is crucial to establish a treatment plan that includes regular monitoring, follow-up assessments, and evaluation of the patient’s response to treatment. Close communication with the patient is important to assess their pain relief, functional improvement, and any adverse effects. Regular reassessment allows for adjustments in the treatment plan and consideration of alternative interventions if necessary.

Overall, the management of chronic back pain requires a comprehensive approach that encompasses non-pharmacological interventions, individualized treatment plans, patient education, and ongoing monitoring. The ethical considerations surrounding prescribing narcotics highlight the importance of balancing pain relief with patient safety, autonomy, and equitable distribution of healthcare resources.

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Ashar, Y.K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T.F. and Kragel, P.A., 2022. Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial. JAMA psychiatry, 79(1), pp.13-23.

Kheirinejad, S., Visuri, A., Suryanarayana, S.A. and Hosio, S., 2023. Exploring mHealth Applications for Self-Management of Chronic Low Back Pain: A Survey of Features and Benefits. Heliyon.
Moura, C.D.C., Chaves, E.D.C.L., Cardoso, A.C.L.R., Nogueira, D.A., Azevedo, C. and Chianca, T.C.M., 2019. Auricular acupuncture for chronic back pain in adults: a systematic review and metanalysis. Revista da Escola de Enfermagem da USP, 53.

Roberts-West, L., Gravatt, A., Guest, N., Hunt, A., Siddique, L. and Serbic, D., 2023. A Comparison of Social Exclusion Towards People with Depression or Chronic Back Pain. British Journal of Pain, p.20494637221148337.

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Study Notes & Homework Samples: Within the Discussion Board area, write 400–600 words »Using the theory of unpleasant symptoms as a guide