professes no religion, and denies suicidal thoughts. Family history is positive for depression. Her current medications include: ● Oxycodone/acetaminophen, 10 mg/325 mg, 1 every 4 to 5 hours as needed for pain (not prescribed). ● Alprazolam 0.5 mg as needed (last dose 2 weeks ago). ● Docusate sodium 100 mg, 1 by mouth twice daily. Vital signs: ● Pain 6/10. ● Weight 145 lb. ● Height 64.” ● Blood pressure 132/84. ● Respiration 14. ● Temperature: 98.2F. Diagnostic tests: ● Urinalysis normal. ● Imaging from a recent. ● ER visit showed fecal impaction. Screening questionnaires: ● SOAAP (Screener and Opioid Assessment for Patients with Pain), negative. ● PHQ-9 (Patient Health Questionnaire for depression), score 10. Working diagnosis: ● Chronic lower back pain (>6 month’s duration). Chronic lower back pain: Taper Percocet (10% decrease in a dose per week) and then discontinue. Start Ibuprofen 800 mg by mouth 3 times daily for 2 weeks. Discontinue alprazolam. Increase exercise education regarding chronic pain and the benefits of using nonopioid pain relievers versus the risks of dependence or abuse with long-term opioid use. The patient agrees to try an NSAID (nonsteroidal anti-inflammatory drug) and will report any withdrawals. The goals are to remain active, increase sleep, and decrease pain by 25% by the next visit. 1. Moderate depression : Fluoxetine 20 mg by mouth daily; arrange psychological counseling. 2. Constipation : Increase water, and fiber; continue docusate sodium 100 mg twice daily. 3. Initial laboratory tests : CBC (complete blood count), CMP (comprehensive metabolic panel), (hemoglobin) A1C, TSH (thyroid-stimulating hormone); lumbar X-ray (radiograph). Beecroft was subsequently booked for re-evaluation in 2 weeks or sooner if symptoms worsen. Her sports medical team was advised to immediately report any thoughts of harming herself or others. A plan to consult a pain ● Moderate depression. ● History constipation. Differential diagnoses: ● A thyroid or other metabolic disorder. ● Anemia, substance abuse, or dependence. ● Degenerative disc disease. ● Osteoarthritis. Therapy plan:
management specialist was also designed for the possibility of worsening symptomatology. Beecroft’s case is a typical pain assessment and management case popular among athletes who consistently push the boundaries of physical limits. As with this case, the treatment goals include early intervention, improved function, treatment of any underlying physical or emotional disorder, and a decrease in the intensity of pain to prevent changes that can occur in the nervous system, which may lead to chronic pain. Self-Assessment Quiz Question #1 What could be considered the primary cause of Beecroft’s lower back injury?
a. Drug abuse. b. Weightlifting. c. Smoking. d. Depression.
Self-Assessment Quiz Question #2 Becroft later developed moderate depression – a common diagnosis in people with moderate to chronic pain. Which of the following could cause this?
a. Immobility and anxiety. b. A schedule of Percocet. c. Beecroft’s inept medical team. d. Constipation.
Self-Assessment Quiz Question #3 In Beecroft’s medical plan, what was the rationale for docusate sodium? a. Depression. b. Anxiety. c. Constipation. d. Smoking cessation. Self-Assessment Quiz Question #4 Which physical therapy was prescribed in this therapy plan?
a. Increased sleep and exercise. b. Cognitive behavioral therapy. c. Cryotherapy. d. Swimming.
Self-Assessment Quiz Question #1 Which of the following risk factors could have probably aggravated Beecroft’s depression diagnosis? a. Drug abuse. b. Social withdrawal. c. A positive family history of depression. d. Tobacco use.
UNDERSTANDING PAIN IN MODERN MEDICINE
Pain, in the context of human medicine, is defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage (Raja et al., 2020). Irrespective of gender, race, and health status, pain appears to affect all people. Following the World Health Assembly declaration of rights, patients have the right to pain relief, and health professionals have an ethical duty to alleviate patients’
pain and suffering. In addition to this declaration, the Joint Commission International has also stressed the importance of pain assessment and management that is designed to meet patients’ medical needs of relief, therapy, and cure (Anekar et al., 2022). The recognition of pain as a vital element to be observed in personal care plans dates back to the late 20th century. In 1996, the American Pain Society introduced pain as the fifth vital sign, along with the vital signs of
Book Code: PYCA2725
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