Question

KT, a 46 yo male, has been disabled for 4 years due to an injury sustained to his lower back at work. He complains of insufficient pain relief throughout the day with bouts of lethargy and constipation most of the time.

Current med list:

Oxycodone/APAP 10/325mg 1 tab tid prn pain

Hydrocodone/APAP 5/325mg 2 tabs 4 times daily prn pain

Alprazolam 1mg 1 tab tid prn anxiety

Gabapentin 600mg 1 tab bid

Surgical history:

several vertebral fusions

Social history:

Smokes 2ppd

Occasional EtOH

How would you manage this person’s pain regimen?

Answer 1

KT , 46 year old male:

His current medications:

* Oxycodone : A very powerful and potentially addictive opioid analgesics medications.

* Hydrocodone : semisynthetic, moderately potent oral analgesic medication.

* APAP: Acetaminophen, a non opioid analgesic, usually used in combination with Opioid analgesics such as oxycodone, Hydrocodone.  

* Alprazolam: An Antianxiety drug

* Gabapentin: a prescription pain killer and derived from Gabapentinoids, an Anticonvulsants.

Pain management:

Chronic pain is one of the great problem suffering  by the patients who have a Spinal cord injury. Many usual prescriptions of pain killers like opioid and NSAIDs are not much effective in controlling this chronic pain suffering by spinal or vertebral injury patients . Many researches showed that the main causes of pain are underlying medical conditions such as musculoskeletal problems, due to overuse of a part or poor posture , and neuropathic pain. In addition to the medications, alternative therapies can contribute greately in pain management.

* Identify the underlying cause of pain like poor posture or overuse. Implement strategies to change the poor posture or overuse .

* Strengthening exercise, physical therapy can help the patient,also moblity and range of motion exercise can also help the patient to relieve from musculoskeletal pain.

*  It is important that before physical therapy and exercises, the patient has to recieve the pain killers like Oxycodone/ APAP. It helps to prevent the pain bouts during or after exercises.  

* Alternative therapies like meditation, counselling, yoga can reduce the pain. ARecent research revealed that counselling reduced the pain to 40 % in Spinal cord injury patients .

* Other alternative therapies are also effective in the reduction of pain, when using in association with analgesics. Such therapies are

- Massage  

- mariguana ( if it is legal for the state)

- acupuncture

- hypnosis

- Chiropractic manipulation

These therapies are Evidence based therapies can be applied for pain relief, according to patient's experience or feed back.

*Provide a fiber rich diet and plenty of fluids to prevent constipation and other discomforts.

* If Alternative therapy is more beneficial, the physician can reduce the dosage of opioids or Alprazolam or gabapentin .

* Deep breathing exercises or musoc therapy also helps in relieving the symptoms.  

* Diversional therapy may divert the patient's mind from pain.

* Smoking and alcohol must avoid by the patient for the effective pain relief.