A 32-Year-Old Lady Arrives at the Emergency Room Seeking Medicine

A 32-year-old lady arrives at the emergency room seeking medicine for acute back pain. She has tried many over-the-counter medications and claims that only oxycodone has alleviated her discomfort. The patient was visited at a pain clinic a year ago, but she can't remember the name of the doctor and her prescription has run out. Obesity and a car accident 10 years ago are among her medical history. The temperature is 37.1 C (98.8 F) , the blood pressure is 130/80 mm Hg, the pulse rate is 76 beats per minute, and the respirations rate is 16 beats per minute. A physical examination reveals no anomalies. A recent MRI revealed no abnormalities. The patient reports that her pain level is a ten on a scale of 0 to ten, and she becomes irritated when the doctor advises nonprescription pain medicine. Which of the following is the most appropriate next step by the physician?

A) Challenge the patient about her drug-seeking behavior
B) Obtain confirmation of the patient's prescription history
C) Order a repeat MRI of the spine
D) Prescribe a 1-week supply of oxycodone
E) Refer patient to a substance abuse rehabilitation program
F) Refuse to prescribe opioid medication and recommend nonpharmacologic pain management