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Posted: June 15th, 2023
History of low back pain
A 53-year-old male presents to you with a 4-week history of low back pain. He does not have an identified traumatic event. He requests something for pain. He has history of alcohol abuse but has abstained for 5 years. He has a 25-pack-year smoking history and is a current smoker. He takes fluoxetine 20 mg po daily for depression.
1. How would you use the Opioid Risk Tool resource to determine his risk for opioid abuse?
2. How would you counsel him regarding treating his pain?
Support your response with a minimum of two APRN-approved scholarly resources.
NOTE: The format of this DQ is different from other weeks. All learners need to address back pain/ORT for this DQ.
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The Opioid Risk Tool (ORT) is a screening tool used to assess the risk of opioid abuse in patients with chronic pain. It takes into account various factors such as age, gender, personal and family history of substance abuse, and history of preadolescent sexual abuse. To determine the patient’s risk for opioid abuse using the ORT, you would assign points to each relevant factor as follows:
Age (53 years old): 0 points (45-64 years)
Gender: 1 point (male)
Family history of substance abuse: 1 point (alcohol)
Personal history of substance abuse: 3 points (alcohol)
History of preadolescent sexual abuse: 0 points (not mentioned)
Psychological disease: 2 points (depression)
Total ORT score: 7 points
A score of 7 indicates a moderate risk for opioid abuse. It is important to consider this risk when prescribing opioids for pain management (Webster & Webster, 2005).
When counseling the patient regarding treating his pain, consider the following:
Educate the patient about the risks and benefits of opioid therapy, especially given his moderate risk for opioid abuse.
Encourage the patient to continue abstaining from alcohol, as it can interact with opioids and increase the risk of adverse effects.
Discuss non-opioid pain management options, such as over-the-counter analgesics (e.g., acetaminophen or NSAIDs), physical therapy, and complementary therapies (e.g., acupuncture, massage, or yoga).
If opioids are deemed necessary, prescribe the lowest effective dose for the shortest duration possible and closely monitor the patient for signs of misuse or abuse.
Encourage the patient to quit smoking, as it can exacerbate pain and negatively impact overall health.
Supporting resources:
Webster, L. R., & Webster, R. M. (2005). Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Medicine, 6(6), 432-442. [https://academic.oup.com/painmedicine/article/6/6/432/1855689]
Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478-491. [https://www.acpjournals.org/doi/10.7326/0003-4819-147-7-200710020-00006]
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