Xavi is a 44-year-old man with complaints of low back pain following a motor
vehicle accident. The accident occurred 7 days ago. He rates his pain 8 out of
- He was prescribed Lortab 5 / 325 in the ER last week. He is requesting a refill
of the Lortab today and indicates it just barely makes him comfortable. What
treatment plan would you implement for Xavi? What medications would you
prescribe and how would you monitor them? What education would you provide
regarding his treatment plan?
Answer the questions below using clinical
practice guideline where applicable. Explain the problem and explain how you would
address the problem. If prescribing a new drug, write out a complete medication order
just as you would if you were completing a prescription.
Treatment Plan for Xavi's Low Back Pain
Introduction
Low back pain following a motor vehicle accident can be debilitating and require a comprehensive treatment plan to address both the pain and the underlying causes. In the case of Xavi, a 44-year-old man experiencing severe pain, an effective and safe treatment approach is vital for his recovery and well-being.
Problem Description
Xavi is currently experiencing significant low back pain, rated at 8 out of 10, following a motor vehicle accident. He was initially prescribed Lortab 5 / 325 in the emergency room, but he now requests a refill as the current medication provides only minimal relief.
Proposed Treatment Plan
1. Medication Adjustment: Considering Xavi's continued pain and the need for effective management, a medication adjustment is necessary. I would prescribe a combination medication that includes both an opioid and an adjuvant for neuropathic pain to address both nociceptive and neuropathic components of his pain.
- Prescription: Gabapentin 300 mg orally twice daily in addition to Oxycodone/Acetaminophen 5/325 mg every 4-6 hours as needed for breakthrough pain.
2. Monitoring Plan:
- Pain Assessment: Regular assessment of pain levels using a validated pain scale to evaluate the effectiveness of the new medication regimen.
- Adverse Effects Monitoring: Monitoring for potential side effects of the medications, such as sedation, dizziness, constipation, or gastrointestinal upset.
3. Education:
- Medication Use: Educate Xavi on the proper use of the new medications, including dosing schedule and potential side effects.
- Non-Pharmacological Approaches: Encourage Xavi to incorporate non-pharmacological approaches such as physical therapy, heat/cold therapy, and gentle exercises to complement the medication regimen.
- Follow-up Care: Emphasize the importance of follow-up appointments to assess response to treatment and make any necessary adjustments.
Conclusion
In conclusion,
the management of Xavi's low back pain post-motor vehicle accident requires a tailored treatment plan that addresses his pain effectively while minimizing potential risks associated with opioid use. By implementing a combination of medications, monitoring for efficacy and adverse effects, and providing comprehensive education, Xavi can receive optimal care for his condition and work towards improved pain control and functional outcomes.
Sources:
1. American College of Physicians. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 166(7), 514-530.
2. Chou, R., Qaseem, A., Snow, V., Casey, D., Cross Jr, 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.
3. National Institute for Health and Care Excellence. (2016). Neuropathic pain in adults: pharmacological management in non-specialist settings. Clinical guideline [CG173].