Allopathic and Alternative Treatment for Chronic Back Pain
Most us have experienced back pain at some point in our lives. According to the national institutes of health nih over 80% of adults experience this problem at some point their life. Lower back pain lbp is a costly affair 2018 from doctors visits days off work and medications various leading organizations estimate the cost lbp anywhere from $50 billion a year to $200 billion a year williams n.d. Many attempts have been made to solve this very expensive problem. Most attempts have included over-the-counter medications prescribed opioid and nonopioid medications and surgery. However the number of people suffering has not changed. My client is one who has suffered with chronic back pain for over 5 years. Assessment my client v. S. Is a 67-year-old woman. She lives with her husband who she has been married to for over 35 years. Her blood pressure was 137/74 and respirations were 16 breaths per minute. I had no access to a temperature probe or an oxygen saturation machine at the time of my interviews since they were conducted in her home. She has a history of osteoarthritis in her knees and was only recently diagnosed as a pre-diabetic. She also suffers from chronic back pain for over 5 years. She has tired over-the-counter analgesics and has consulted her physician about the problem. Her physician had previously prescribed other analgesics which she said worked for a while.
However she stopped taking them because she felt like she had no energy to do anything else when she was medicated. She says that most days she her pain is about a 6 on pain scale ranging from 0 to 10 0 being no pain 10 being the worst pain. She self-medicates with ibuprofen 500 mg four times a day qid when her pain is over 7. She is also lactose-intolerant. She is also very near sighted and has to wear glasses to be able to go about her everyday responsibilities. V. S. And her husband are retired. Neither of them has ever smoked or used alcohol. They have no children of their own although they have adopted international students who go to the nearby university. She is very involved with the international community in her town. She goes for a walk every morning and she estimates that she walks at least a mile every day although she says she is getting slower. She had no hospitalizations over the last two decades. However she visits her general physician at least once a year usually more often if her pain is unbearable. She is also a faithful church goer and goes to church every week. A major barrier to compliance with interventions with v. S. Is that she generally does not like taking medications. She is concerned that taking medication for pain will make her dependent on medication for pain control. From our conversation i gathered that she was more open to trying alternative or complimentary therapy for pain.
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Nursing diagnosis and goal chronic pain related to advanced age and untreated joint condition as evidenced by self-report of intensity of pain using a standardized pain scale. The goal is for my client to verbalize decreased pain at the end of two months. Biomedicine interventions dr. Thomas staiger barak gaster mark sullivan and dr. Richard dayo 2003 in their article systematic review of antidepressants in the treatment of chronic low back pain suggest that tricyclic tca and tetracyclic antidepressants can produce moderate amounts of analgesia in patients who suffer from chronic back pain. Staiger et al found that compared to selective serotonin reuptake inhibitors tcas were more effective in treating various kinds of pain. They compared various studies on different antidepressants used to treat back pain. Specifically use of nortriptyline or maprotiline were studied. They also found that regardless of the patients depression status tcas and tetracyclic improved the functional status. However the paper did not discuss the risks of treating back pain with antidepressants. The second biomedicine intervention is the use of transdermal fentanyl tdf dr. Laurie allan dr. Ute richarz dr. Karen simpson and dr. Robert slappendel 2005 compared the side effects and efficiency of tdf with that of sustained release morphine srm after studying almost 700 patients for 13 months dr. Allan et al 2005 found that both tdf and srm had comparable analgesic effects. However patients that used tdf were less likely to experience constipation as compared to patients who were prescribed srm. Other common side effects were nausea and vomiting.
This meant that there was a need for prophylaxis before the administration of these medications. In this randomized study the medication dose was carefully titrated for each patient. This meant that this could not be a double-blind study. Also all patients in this study were previously strong opioid na??ve. Alternative medicine fran?§a burke caffaro ramos and marques conducted a randomized controlled trial comparing the effects of muscular stretching versus segmental stabilization on lower back pain. Participants were randomly divided in two groups and were asked to attend a six-week biweekly program. Pain was assessed after and before the intervention. After six weeks participants that we assigned to segmental stabilization reported a great decrease in pain compared to those assigned to muscular stretching. The advantages of this practice would be that it could easily become part of v. S.s schedule. Since she is keener on using alternative therapies v.s. Might be more open to using ss instead of a drug treatment. However a disadvantage to this would be that she would have to find a practitioner who is trained in ss for back pain. This might not be covered by her insurance. The second alternative medicine intervention is tai chi. Tai chi has been practiced in china for centuries. It is still practiced in many parts of the world today. Much research has been done on the benefits of tai chi.
Research has shown that this ancient exercise can help relax and strengthen the musculoskeletal system. In a meta-analytic study kong et al found that tai chi was beneficial for chronic oa pain and some beneficial evidences of tai chi for lbp and osteoporosis kong et al 2016 another study argued that there were no side effects from tai chi therapy fran?§a et al 2012 v.s. Finds this therapy most appealing since this therapy is slow-paced and also gentle on the joints. She has also found a group in the local community that practice tai chi once a week. Evaluation of all the interventions suggested above only two were appealing to v.s. However she has decided to consult with the physician about all the interventions before making her final decision. She assured me that she was going to try out tai chi since she had not heard about it before and was curious to see what it could do for her pain. She also asked me to share the research i have found on the effectiveness of tai chi with her so that she could read them for herself. V. S. Has had the opportunity of reevaluate the treatment for her chronic back pain. She was given multiple options for treatment to choose from. After discussing with her physician she plans to make decided efforts to better treat her back pain.