Pain Case Study

The Aiken Area Office Supervisor, Training Center Manager, Counselor, and Client participated in a meeting on 06/23/2016 with the Ombudsman participating in the meeting via telephone. The goal of the meeting was to review the Client's up to date records. According to the records, the Client had dealt with an addiction to pain medication. This issue has since been resolved. The Client was offered a referral to the upcoming Pain Mgt Clinic at the Evaluation Center prior to her starting JRT or she could enter JRT, but if the Client is referred back to JRT in the future, she would have to complete the Pain Mgt Clinic as a pre-requites to entering in JRT. The Client decided to enter JRT first after she completed her bone marrow test on 7/11/16.

On January 4, 2011, Ms. Carey presented to Florida Rehabilitation and Injury Center with complaints of upper back and mid back pain. Ms. Carey described the constant sharp, dull and aching pain as a 5 on a scale of 1 to 10. Ms. Carey underwent physical therapy, hot pack therapy and electrical muscle stimulation.

On admission, Mr. Fountain complained of low back pain, ranging in intensity between 7 and 10, on a pain scale where 0 is no pain and 10 is the worst possible pain. He subjectively described this pain as a constant ache that permeates down into both legs, anteriorly and posteriorly, but at times can be stabbing, sharp, and burning. Sitting, standing, walking or lying down for prolonged periods can aggravate his back pain, while treatment modalities such as medications, nerve block injections, medical cannabis, TENS therapy, massage, and application

V.S described unwavering compliance with her medication schedule. She takes Lisinopril and Levothyroxine at 0800, and Ativan at 0000 before bed (works 1500-3200).

By this point in time, the opioid crisis is well-known and concerning. One potential solution suggested by researchers, medical professionals, and individual patients alike is the use of medical cannabis for treatment of conditions such as chronic pain. In fact, many patients now prefer medical cannabis to opioid treatments. It’s not difficult to see why.

Past trials of adjuvant pain medications may have failed to control the pain because of factors such as a sub-therapeutic dose or duration of the medication. We reviewed the role of duloxetine in the management of both neuropathic and nociceptive pain conditions and suggested a retrial of this SNRI. She agreed with our recommendation and began a 2-week trial of duloxetine, 30mg/day, which she tolerated well, thus; her dose was subsequently increased to 60mg/day, the usual effective dose for both pain and mood.

The patients who are in pain requires pain relief, but many of them with chronic pain have trouble with prescribed opioids either due to psychosocial problems

Opioids are effective for the treatment of acute pain, such as pain following surgery. They have also been found to be important in palliative care (hospice) to help with the severe, chronic, disabling pain that may occur in some terminal conditions such as cancer. In many cases opioids are successful long-term care strategies for those with chronic cancer pain (CCP). There are not many alternatives for those with CCP like there are for those suffering acute or chronic non cancer pain (CNCP). In one study, conducted by Furlan et al. (2006), opioids were effective in the treatment of CNCP overall; they reduced pain and improved functional outcomes better than placebo. Strong opioids (oxycodone and morphine) were significantly superior, to naproxen and nortriptyline (respectively) for pain relief but not for functional outcomes. Unfortunately, Weak opioids (propoxyphene, tramadol and codeine) did not significantly outperform NSAIDs or TCAs for either pain relief or functional outcomes. Overall, if opioids are

As per office notes dated 8/26/16 the patient complains of dull and aching pain of the neck. She rates it as 7 without the medications and at 5/10 with medications. Pain is aggravate with activities and relieved with rest and medications. Neck pain us associated with headaches and radiating pain, tingling, and numbness to bilateral upper extremities. Patient is complaining of having acid reflex ad acute exacerbation of muscle spasm. Lumbar back pain is dull and aching rated at 6 without medications and 4 with medications. Pain is aggravated with activates such as forward back bending, lifting, prolonged sitting, standing, walking, and it is relieved with rest and medications. Lower back pain is associated with radiating pain, tingling, and

Mr. Anderson continues to report subjective pain levels that reach an 8 now instead of the over 10 he did have. The decrease in his pain level was with spinal cord stimulator and with the slight decrease of pain medications. He continues to treat for a nonrelated cervical issue and now has added knee pain. He has had 2 prior knee replacements. Mr. Anderson has stopped mentioning a return o work. Dr. Shah has placed him at MMI from a surgical standpoint. He will now solely treat with the pain clinic. Dr. Rampersaud is now planning on changing the pain medication to Nucynta. I have concerns about the medication in regards to Mr. Anderson’s Barrett Disease, and how accurately the medication is monitored and also if there is still a plan to

Mr. B is experiencing several types of pain during the postoperative period. He is experiencing acute pain from the healing process of his surgery. This is from tissue damage from the surgical procedure. Although the reported pain level is ten on the Numeric Rating Scale (NRS), the Critical Care Pain Observation Tool (CPOT) score is seven. Mr. B may also be experiencing chronic pain prior from the surgery. The date noted from onset of pain is unknown in the case study but he has a history of degenerative disk disease could be a cause of chronic pain.

Frances DeForrest BSN, RN is currently working with children in summer camp and school nurse settings. Her interest in Hemp and Cannabis as Medicine  has developed through self -study, attendance of Cannabis Science themed conferences and events. Earning Cannabis CEU’s in 2009 though UC Berkeley online and the first offered Certificate of Cannabis for Nurses in 2014, as offered through Patients out of Time. Most recently, Frances has enrolled in the first Cannabis Science Post Bachelor’s degree certificate coursework offered in the United States through the University of Vermont- Lerner College of Medicine. This is expected to be a nice addition to her clinical BSN coursework. Which was completed in 2015 in coordination with Drexel University

Pain assessment – finding out client’s pain coping mechanisms when applying pressure to the tissue and the client tells you that it feels good this tells me the therapist it is having an analgesic effect. This client may suffer a harmful pain indicated by a muscle contraction or the male pushing against the movement that the therapist is applying, so it’s important for client to be vocal and tell you when it hurts. When assessing pain, try to determine as accurately as possible which structure is affected whether the tissue is healthy enough to receive massage is to apply slow pressure to the area with your thumb. If the pain subsides within 10 seconds, massage is fine; if pain increases the situation is too acute and you should implement protocols

Objective data that should be assessed are, pain assessment should be conducted by asking the patient his pain levels by using the Position/Provoking, Quality Radiate, Severity, and Time (PQRST) method, keep an eye on the patient's facial expressions they may also grimace or wince in pain, this is to assess the amount of pain he is in and see if you may need to contact a doctor to review his pain medication dosage. Does Mr Jones look clammy/sweaty? Is he short of breath(SOB), monitoring the way he is breathing e.g. shallow or deep, is he struggling for breath? he may even have noticeable cyanosis, is there anything that makes the pain better or worse? Checking the capillary return It is used to monitor the amount of blood flow to tissues.

Chronic pain has plugged into thousands and millions of people in this fast developing world. There are number of cases found suffering from chronic pain conditions and takes a long period of time to recover. People tempt to get chronic pain relief through some natural ways. Around 50 to 80 millions of Americans are suffering form chronic pain condition. The chronic pain if treated at an earlier stage can be well treated but if it sustains for a longer period than the situation can become worse. Chronic pain relives the flow of harmful hormones, such as cortisol which plays a major role in adversely affecting the immune system and kidney function.