Introduction
At the primary care facility, a patient named Mr. X complains of lower back pain. The patient attributes his chronic and recurring lower back pains to a skiing accident he was involved in ten years ago. After moving some boxes three days ago, he started feeling a pulling sensation in his lower back. The intensity of the pain increased over the next 24-hour period. The pain is steady now and rated at between three and four on a scale of one to ten. Mr. X also has type-2 diabetes which is well controlled by medication (metformin with an HGA1c of 5.6). Additionally, he has a history of DVT which was diagnosed four months ago and for which it was recommended that he takes Coumadin, INR is WN. He has a specialist who helps him manage this problem. Recently, he started taking two over-the-counter medications namely kavakava and CoEnzyme Q10 on the advice of a friend for what he says is to control anxiety. Mr. X has smoked for the past 15 years at a rate of one pack each week.
Diagnosis
The diagnosis of Mr. X is acute pain caused by muscle strain. Muscle contraction is coordinated through the nervous system and they are typically surrounded by an outer sheath that facilitates smooth movement of muscles over the surrounding tissues. A muscle strain occurs tissue begins to tear as a result of immense force on a muscle. A tissue tear can occur in one of three places: within the muscle, at the intersection between the muscle and a tendon, and at the point a tendon attaches to the muscle (Roger et al., 2017). Muscles provide the requisite force for movement through tendons attached to the bones. However, the force can be so immense that it tears the tissue partially or completely (Ishøi et al., 2020). This kind of injury occurs if there is excessive loading of the muscle such as when lifting and moving some boxes (Roger et al., 2017). However, the severity of the injury can range from grade 1 to grade 3 rupture which allows a physician to estimate the time needed for the patient to recover.
Chronic pain due to the skiing accident ten years ago was ruled out because the patient’s symptoms were more consistent with a muscle strain than recurring pain due to a skiing accident. The patient experienced sudden pain that kept escalating for 24 hours and remained steady afterward (Kundu, 2018). At the time he experienced pain, he had been moving boxes from one place to another suggesting a grade two muscle strain. Grade two muscle strain is characterized by extensive damage to the muscle but without complete rupture. The patient’s movement and strength are significantly hampered. Mr. X’s motion in the back was decreased by 25 percent and he had difficulty getting on the examination table. Hence, his injury and accruing symptoms support a grade two muscle strain diagnosis.
Prescription
The United States CDC recommends that physicians refrain from recommending opioids for the management of acute pain. According to them, opioids are generally ineffective and an individual would be better off with nonsteroidal anti-inflammation medication combined with nonpharmacological treatment (Qaseem et al., 2017). Thus, because acute pain reduces over time, CDC’s guidelines recommend that physicians offer patients nonpharmacological treatment that combines non-opioid pharmacological options to manage inflammation.
In line with this recommendation, a prescription of Lidocaine Patch and Tylenol as medication for Mr. X’s muscle strain injury is recommended. Lidocaine Transdermal patch is used to relieve pain in the shoulders, arms, necks, and backs by adults and children. The Lidocaine patch is to be applied on dry, clean, and intact skin. Mr. X may apply up to three patches at a time. However, the patches should never be worn for more than twelve hours (Santana et al., 2020). Thus, he will need to apply new patches twice each day for at least a week. Tylenol is used to relieve a patient of mild or moderate pain from muscle pain, menstrual pain, and headache and it is taken orally as a tablet. Consequently, Mr. X will take two tablets of Tylenol three times each day for seven days. Other than the pharmacological treatment recommendations, non-pharmacological options that will help the patient get rid of the pain faster will be prescribed.
Lidocaine gets into an individual’s bloodstream through subcutaneous infiltration where its proceeds to be absorbed into the circulatory system. The absorption into the bloodstream can take 24 hours or less and it is eliminated from the body through hepatic metabolism. The metabolism of Lidocaine takes place in the liver with the metabolism rate varying from one individual to another. The enzyme P450 is responsible for breaking down Lidocaine in the liver which is then excreted through urine as 90 percent metabolites and 10 percent unchanged drugs (Santana et al., 2020). Due to the rapid rate of metabolism, once absorbed into the circulatory system, Lidocaine takes two to three hours before it is excreted through urine. On the other hand, Tylenol gets into the circulatory system through passive diffusion from the small intestines. The absorption process takes place less than seventy minutes after taking the medication (Shavlovskaya, 2019). Like lidocaine, Tylenol is metabolized through the liver and excreted as urine twelve to twenty fours hours after taking the medication.
Consequently, the patient is to take cannabis only when his pain exceeds four on a scale of one to ten. The patient should use peppermint oil which he needs to apply to his lower back because it helps with muscle pain relief (Seladi-Schulman, 2022). Chiropractic and weight loss strategies will also be recommended for the patient. Chiropractic will prevent the deterioration of the musculoskeletal system due to the muscle strain suffered on the back (Shavlovskaya, 2019). On the other hand, weight loss strategies will help the patient stay fit during the recovery periods because he will not be able to exercise regularly or lift any heavy load.
Type of Education Needed
The patient requires education on using over-the-counter (OTC) drugs. The patient is already using two over-the-counter drugs where one is for the treatment of anxiety and the purpose of the second one is not known. To educate the patient, principles of therapeutic communication that include empathy, self-awareness, and authenticity will be essential when explaining the dangers of taking OTC medication that is not prescribed by a physician (Merlo, 2021). To assess whether the patient has grasped what has been taught, a scheduled appointment three days later will be made where the patient will be expected to have discarded the OTC medication on his initiative.
Conclusion
Mr. X’s lower back pain is not the result of the decade-old injury he sustained while skiing. Instead, his injury is a grade two muscle strain sustained as a result of lifting boxes and taking them from one place to another. Consequently, a prescription of a Lidocaine Patch and Tylenol will appropriately address the pain and allow his muscles to heal comfortably. Other non-pharmacological prescriptions such as peppermint oil, cannabis, chiropractic, and weight loss strategies will also relieve the pain and allow him to recover properly. Due to his harmful habit of self-medicating using OTC drugs, Mr. X needs a lesson on the dangers of using medication that has not been prescribed by a doctor.
References
Ishøi, L., Krommes, K., Husted, R. S., Juhl, C. B., & Thorborg, K. (2020). Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport – grading the evidence: A statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). British Journal of Sports Medicine, 54(9), 528–537. Web.
Kundu, P. (2018). An effective treatment technique for professional athletes with lower back pain. International Journal of Physical Education & Sports Sciences, 13(1), 61–65. Web.
Merlo, G. (2021). Principles of Medical professionalism. Oxford University Press.
Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (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), 514–539. Web.
Roger, B., Guermazi, A., & Skaf, A. (2017). Muscle injuries in sport athletes: Clinical Essentials and imaging findings. Springer.
Santana, J. A., Klass, S., & Felix, E. R. (2020). The efficacy, effectiveness, and safety of 5% transdermal lidocaine patch for chronic low back pain: A narrative review. PM& R, 12(12), 1260–1267. Web.
Seladi-Schulman, J. (2022). Peppermint oil: Uses, benefits, side effects, and Safety Risks. Healthline. Web.
Shavlovskaya, O. A. (2019). Treating a patient with lower back pain. Medical Council, (12), 25–32. Web.