Chronic Back Pain

    NextPrevious

    Chronic Back Pain

    You’re working overnight when your 10th patient comes in complaining of chronic back pain. You order acetaminophen and an NSAID but the patient refuses to take them. They’re upset, agitated and demanding their usual percocet as its the only thing that helps. You attempt to explain that opioids are not the best medication for this type of pain but the patient does not even let you finish your sentence. you decide to use this time to educate your patient.
    A recent RCT done randomized 240 patients with chronic back, hip or knee pain to opioid versus non-opioid medications. The opioid group was given immediate release opioids before escalation to sustained action or transdermal therapy. The non-opioid group received acetaminophen and NSAIDs before escalation to therapies including gabapentin, lidocaine and capsaicin. the primary outcome was pain-related function at 1 year using a a scale 0-10 with 10 being worse. At the end of the study there was found to be no difference between the two groups. Pain intensity actually favored the non-opioid group (although this may not be clinically significant). You also take this time to discuss the many undesirable medication related symptoms including the potential for abuse when using opioids from chronic pain.
    Your patient seems receptive and appreciates the time you took to explain this.
    The next time you’re on shift and have concerns that your patient may be misusing opioids you can print this card out for them at:
    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • It’s Freezing!

      You are at elmhurst in the cardiac room. It is FREEZING outside. The triage nurse tells you there is a frequent flier in triage, EMS found him sleeping on the street with +AOB. He isRead more

    • pediatric blood transfusion

      So you’re in peds and your patient is anemic. You need to transfuse, but you are confused. How much blood do you give? How fast do you give it? How much: The volume of bloodRead more

    • Spontaneous Pneumomediastinum

      Your patient is a 24 yo M with chest pain.  It is pleuritic. He has normal vitals and you’re not too concerned. You get a CXR and you see the result in this post. HeRead more

    • In flight emergencies and when to land the plane

      You are on a flight, halfway across the Atlantic Ocean at the start of a much needed vacation, binge watching that new show everyone has been talking about but you’ve never had time to see. Read more

    • PE risk stratification: which tool is best?

        Your patient with a newly diagnosed PE hates hospitals.  He or she agrees to defer to your judgement about admission versus discharge home, but makes it clear they would prefer to go home ifRead more

    • Proper cane use

      We give out canes like they’re candy.  But are we doing a good job adjusting the cane and teaching patients how to use them?  Canes that are not the right height for your patient orRead more

    • Do antivirals or steroids help make shingles better?

      A patient comes to the emergency department reporting a few days of excruciating pain in a band around his right chest.  Today, he developed vesicles over the same area which prompted him to come in.Read more

    • Double Sequence No-no???

        You are the leader of the code team.  Your patient is in refractory VF after multiple rounds of shocks and drugs.  You’ve tried repositioning the pads into an anterior-posterior position.  Looking around, you askRead more

    NextPrevious