A 27-year-old man comes to the office for follow-up regarding a herniated disc. He first injured the disc 3 months ago while at work. Nonsurgical treatment options, including physical therapy and as-needed NSAIDs and tramadol, were recommended. The patient has completed physical therapy, and follow-up MRI indicates that the herniated disc has regressed. He reports a significant amount of ongoing pain and asks for a dose increase and refill of his pain medication. In the past month, the patient has been to the emergency department on 2 occasions to request pain medication due to running out before his next scheduled refill. Vital signs are within normal limits, and physical examination is unremarkable. Which of the following statements by the physician would be most appropriate at this time?

Question

A 27-year-old man comes to the office for follow-up regarding a herniated disc.  He first injured the disc 3 months ago while at work.  Nonsurgical treatment options, including physical therapy and as-needed NSAIDs and tramadol, were recommended.  The patient has completed physical therapy, and follow-up MRI indicates that the herniated disc has regressed.  He reports a significant amount of ongoing pain and asks for a dose increase and refill of his pain medication.  In the past month, the patient has been to the emergency department on 2 occasions to request pain medication due to running out before his next scheduled refill.  Vital signs are within normal limits, and physical examination is unremarkable.  Which of the following statements by the physician would be most appropriate at this time?

Quizplus · Accepted Answer

Eductional Objective: Because pain is subjective, clinicians must use clinical judgment to combine effective pain management with medication overuse and misuse avoidance. Prescription opioid abuse has grown more common in recent years. Not taking medicine as recommended, asking early refills, obtaining pills from various physicians or illicit sources, requesting greater doses, and ignoring alternative pain-management measures are all signs of overuse.
This patient is exhibiting symptoms of opioid use disorder, including: running out of medicine too soon; receiving prescriptions from emergency departments rather than the primary prescriber; tolerance (requiring greater dosages to achieve the same effect); and dependency. Confronting the patient about usage, on the other hand, is unlikely to be beneficial at this time.
The most appropriate initial action is a patient-centered approach: validating the patient's concern about pain control; engaging the patient in a nonjudgmental, collaborative discussion of how he is using the medication; and exploring reasons for the escalating use

A 27-Year-Old Man Comes to the Office for Follow-Up Regarding