A 45-year-old male with a past medical history significant for chronic low back pain presents to the ER with back pain. You overhear the ER tech saying, “I hate chronic pain patients. They just want narcotics, and now I have to clean up his pee because he can’t get his stuff together.” Based upon this complaint and additional information, what are potential diagnoses? What testing should be employed? What referrals should be initiated? Should any pharmacological treatment be initiated? Should any nonpharmacological treatment be initiated? If opioid prescribing would be considered, what factors would need to be considered to prescribe responsibly? Justify your decisions with a rationale. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.
Back Pain
Chronic back pain caused by non-mechanical issues is a serious concern that requires immediate medical attention. In this case study, the patient presents with chronic back pain and from the ER tech’s comment, the patient is also experiencing urinary incontinence. Chronic back pain and urinary incontinence could be an indication of nerve problems. For example, a possible diagnosis could be a Cauda equina syndrome (CES), which is characterized by compression of the cauda equina sac of nerves at the root of the spinal cord, resulting in lower back pain and incontinence (Lavy et al., 2022). Another potential diagnosis is neurogenic bladder disorder, which occurs from nerve injuries and nerve compression.
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A problem with the nerves requires physical examination to evaluate the sensation, reflexes, strength, stability, motion, and alignment (Zusman et al., 2022). One of the tests that can be done is an MRI, which is needed to confirm the diagnosis of CES. The second test that would be needed is cystoscopy. The tests are done by inserting a thin flexible tube through the urethra to check structural changes or blockages in the urinary tract. Similarly, urodynamics may also be conducted on the patient.
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A 45-year-old male with a past medical history significant for chronic low back pain presents to the ER with back pain. You overhear the ER tech saying, “I hate chronic pain patients. They just want narcotics, and now I have to clean up his pee because he can’t get his stuff together.” Based upon this complaint and additional information, what are potential diagnoses? What testing should be employed? What referrals should be initiated? Should any pharmacological treatment be initiated? Should any nonpharmacological treatment be initiated? If opioid prescribing would be considered, what factors would need to be considered to prescribe responsibly? Justify your decisions with a rationale. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.
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The referrals that should be initiated include the urologist for bladder issues and a neurologist to address nerve problems and other neurological issues responsible for the patient’s condition. Pharmacological treatment would be initiated for the pain, for example, naproxen (Wewege et al., 2020). Nonpharmacological options are also helpful for pain management. For example, encouraging light exercise and massage may help relieve pain. If opioids are prescribed for pain management some of the factors that need to be considered include the risk of misuse or harm, for example, addiction or overdose, assessing baseline pain, setting criteria for stopping, and prescribing the lowest dose of short-acting opioids (CDC, 2020).
References
CDC. (2020). Checklist for prescribing opioids for chronic pain. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/pdf/pdo_checklist-a.pdf
Lavy, C., Marks, P., Dangas, K., & Todd, N. (2022). Cauda equina syndrome-a practical guide to definition and classification. Int Orthop, 46(2):165-169. doi: 10.1007/s00264-021-05273-1.
Wewege, M., Bagg, M., & Jones, M. (2020). Analgesic medicines for adults with low back pain: protocol for a systematic review and network meta-analysis. Systematic Reviews, 9, 255. https://doi.org/10.1186/s13643-020-01506-3.
Zusman, N., Radoslovich, S., Smith, S., Tanski, M., Gundle, K., & Yoo, J. (2022). Physical Examination Is Predictive of Cauda Equina Syndrome: MRI to Rule Out Diagnosis Is Unnecessary. Global Spine Journal, 12(2):209-214. doi:10.1177/2192568220948804.
A 45-year-old male with a past medical history significant for chronic low back pain presents to the ER with back pain. You overhear the ER tech saying, “I hate chronic pain patients. They just want narcotics, and now I have to clean up his pee because he can’t get his stuff together.” Based upon this complaint and additional information, what are potential diagnoses? What testing should be employed? What referrals should be initiated? Should any pharmacological treatment be initiated? Should any nonpharmacological treatment be initiated? If opioid prescribing would be considered, what factors would need to be considered to prescribe responsibly? Justify your decisions with a rationale. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.
Struggling to meet your deadline ?
Get assistance on
A 45-year-old male with a past medical history significant for chronic low back pain presents to the ER with back pain. You overhear the ER tech saying, “I hate chronic pain patients. They just want narcotics, and now I have to clean up his pee because he can’t get his stuff together.” Based upon this complaint and additional information, what are potential diagnoses? What testing should be employed? What referrals should be initiated? Should any pharmacological treatment be initiated? Should any nonpharmacological treatment be initiated? If opioid prescribing would be considered, what factors would need to be considered to prescribe responsibly? Justify your decisions with a rationale. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.
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