Pharmacology 3rd Edition by Michael Adams , Carol Urban

Exercise 5

Remember the patient "Larry Smith" at the beginning of the chapter? Now read the remainder of the case study. Based on the information presented within this chapter, respond to the critical thinking questions that follow.

Larry Smith was being seen for an outpatient presurgery work-up the evening before scheduled urologie surgery. The nurse conducts a thorough history and examination related to his back pain and current pain management. His anticipated hospital stay is 2 days postsurgery.
Larry Smith is a 64-year-old male. Vital signs are blood pressure, 108/64 mmHg; pulse, 88 beats/min; respirations, 16 breaths/min. He has a well-healed midline scar on his back from lumbar vertebrae surgery, with a shorter scar over his right iliac crest. He moves a bit slowly with some limited lumbar range of motion. He also uses a cane for ambulating any distance. He describes his pain as a constant dull ache in the lower back that increases with prolonged standing or walking. Mr. Smith also reports a feeling of "cold electricity" down both legs, with the left greater than the right, which increases with standing and walking, as well as numbness of the middle toes on his left foot. He has been using mixed opioid and nonopioid analgesics for past 8 years and previously had used SSRI antidepressants as adjuvant for his pain. His current health care provider weaned him off Vicodin ES about a year ago. He now takes methadone 20 mg twice a day. When the pain is not relieved he uses Norco for breakthrough pain. His use of Norco is 1 to 2 per day. Constipation is an ongoing problem, requiring stool softeners and occasional laxatives.
How should Larry's postoperative pain be managed? Is there a referral the nurse can make to facilitate effective pain management?