Therapy plan: 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 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?
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.
a. Drug abuse. b. Weightlifting. c. Smoking. d. Depression.
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, represents one of the oldest challenges. Pain has a valuable role in medical action as the symptom par excellence and, therefore, as a precious and meaningful tool. An important step forward in the scientific characterization of pain has been taken with Sherrington’s definition of the phenomenon as “the psychical adjunct of an imperative, protective reflex” and the description of its neurophysiological aspects.1 Nevertheless, it is only with the discovery of abnormal pains that the phenomenon and its role start to be directly addressed in medicine, and that is when the traditional interpretation of pain as a symptom of disease starts to weaken.
along with the vital signs of temperature, respiratory rate, blood pressure, and pulse rate, emphasizing the importance of pain assessment. This recognition further established pain assessment as an important step in pain management. Inadequate pain assessment and management adversely affect patient outcomes, including prolonging the length of hospital stay and delaying patient recovery (Liyew et al., 2020). Medical professionals are directly and indirectly laden with the responsibility of appropriately assessing and managing patients’ perceptions of pain in different medical conditions. However, these responsibilities are not without a few bottlenecks and barriers. Some of the factors identified as barriers to effective pain assessment and management in modern medicine include personnel who lack of knowledge and skills, poor teamwork, high workload, lack of medical team–patient communication, and inadequate time. Drawing medical inspiration from his research on this subject, John J Bonica, the founding father of Pain Medicine, 1953, wrote: “Pain, in its late phases, when it becomes intractable, it no longer serves a useful purpose and then becomes, through its mental and physical effects, a destructive force.” In John’s view, the peculiar nature of pain is revealed in its complexity, particularly because of the double value of the phenomenon, that is, pain is biologically a protective tool, but it can also lose its adaptive function and become a pathologic condition severely impacting the quality of life. An attempt to formulate a generally accepted understanding of this concept
Evolution of pain descriptions in modern medicine: A disease or an autonomous entity? In the history of medicine, the attempt to understand pain
Book Code: PYFL4024
Page 122
EliteLearning.com/Psychology
Powered by FlippingBook