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Chronic pain is a condition of pain caused by an unresolved injury. Usually, a pain is considered chronic, if it persists for more than 3 months. It is not only a symptom of other problems but can be a syndrome having both physical as well as psychological dimensions. In order to evaluate the chronic back pain, detailed history of the patient has to be taken and thorough physical assessment has to be done (Buttaro, 2013).
Evaluation of a patient with back pain
Pain assessment can be done by the use of a mnemonic device, PQRST. P is related to provocative-palliative factors such as temperature, particular positions and/or movement, or activities. Q is related to quality including the description of pain as, for example, boring, dull, electrical, or aching. R is related to the region or site of pain as, for example, back pain. S is related to severity, and can be obtained by rating the pain on a scale from 1 to 10. T is related to timing of pain as, for example, during the day or night (Buttaro, 2013).
In order to examine the low back pain, gait of the patient is checked. The skin as well as lower extremity vascular system is also examined. Spinal examination can also be done to check the symmetry of paraspinal muscles. Neurologic examination is done to assess the symmetry of the patient’s strength in hip, knee, ankle, and foot movement (Buttaro, 2013).
Other sources of low back pain are also evaluated as, for example, infection, fracture, neoplasm, inflammatory diseases, and medical causes. Moreover, “Red flags” that are often nonspecific may lead to further imaging and serologic activities. Red flags may include weight loss, history of constitutional symptoms, previous history of malignant diseases, and nocturnal exacerbation of pain. In the evaluation of the back pain, it is also important to consider the drug abuse as medications such as opioid analgesics can lead to drug abuse (Buttaro, 2013).
Ethical implications for prescribing narcotics for chronic back pain
Usually, oral over-the-counter analgesics such as nonsteroidal anti-inflammatory drugs and acetaminophen are prescribed. However, they may not show adequate response in some patients of chronic back pain; so, opioid analgesics are prescribed. In this case, it is important for the prescribers to carefully and frequently reassess the condition of the patient and his or her proneness to drug abuse (Buttaro, 2013).
Ethical implications in the prescription of narcotics or opioids include the principle of beneficence, principle of nonmaleficence, respect for autonomy, and principle of justice. In the principle of beneficence, a health care provider has to provide net benefit to the client or patient. Usually, health care professionals are well-aware of the benefits provided by opioid analgesics. In the principle of nonmaleficence, a health care provider tries to reduce or eliminate the harms that can be caused by narcotics or opioid analgesics. In the respect for autonomy, interventions have not to be imposed on the competent patients. Respect for autonomy can be achieved by informed consent of a treatment or informed decline to the treatment. In the principle of justice, health care providers have to consider the fair as well as equitable treatment of all (Kotalik, 2012).
What would be the prescription and why?
It is better to start treatment with non-steroidal anti-inflammatory drugs and acetaminophen. However, opioids can be used as it is helpful in giving more relief from pain and in performing daily activities more easily as compared to placebo. Moreover, it is important to note that the safety and efficacy of opioids used for more than 4 months are not clear. Therefore, opioids can be prescribed, if the patients are not responsive to other medications, but they have to be prescribed for shorter periods of time (Chaparro et al., 2013).
References
Buttaro, T. M. (2013). Primary Care: A Collaborative Practice: Elsevier/Mosby.
Chaparro, L. E., Furlan, A. D., Deshpande, A., Mailis‐Gagnon, A., Atlas, S., & Turk, D. C. (2013). Opioids compared to placebo or other treatments for chronic low‐back pain. The Cochrane Library.
Kotalik, J. (2012). Controlling pain and reducing misuse of opioids Ethical considerations. Canadian Family Physician, 58(4), 381-385.
