Introduction
Conditions such as osteoarthritis, muscle or ligament strain, disc herniation, spinal stenosis, and osteoporosis may cause chronic low back pain. In this case, osteoarthritis is ruled out because the patient does not exhibit signs of swelling or tingling of the legs (National Institute of Aging, 2022). Mr. X is unlikely to suffer from disc hernia or spinal stenosis because the negative straight leg lift and intact deep tendon reflexes (DTR) suggest no nerve damage. Equally, the patient does not have osteoporosis because there is no sign of fractures or a stooped posture. Therefore, Mr. X’s low back pain is due to a muscle strain that may have resulted from injuries caused by his skiing accident.
The Patient’s Diagnosis
Based on the presented symptoms, Mr. X has a lumbar muscle strain, also known as a pulled-back muscle. The patient’s history of chronic low back pain after the skiing accident and recent pain after moving some boxes suggests a musculoskeletal cause. Additionally, the gradual buildup of pain over 24 hours and the achy nature of the pain are indications of strained muscles. Similarly, the intensified pain on movement, occasional spasms, slight difficulty getting on the examination table, and a reduced range of motion (ROM) of the back also support this diagnosis (Huang et al., 2021). A diagnostic test is unnecessary because the patient’s history and physical exam can help establish the cause of the low back pain.
Treatment Plan
Lumbar muscle strain is treatable, and most individuals may recover within a short period. Non-drug approaches are recommended as the first line of treatment. In this case, heat packs may help alleviate low back stiffness and pain (Traeger et al., 2021). Placing a heating pad at the affected region boosts blood circulation, relieving the strained muscles’ tension and improving healing. In addition, massage therapy can help relax the muscles, increase ROM, and lessen the ache (Traeger et al., 2021). These techniques may be effective in improving the patient’s condition.
Other non-pharmacologic interventions suggested for Mr. X include activity modification. The patient is required to avoid strenuous actions, such as heavy lifting, to prevent the deterioration of the muscle injury. In addition, staying active by engaging in short-distance walks may help reduce the stiffness of the back and ease the pain (Traeger et al., 2021). Equally, placing ice packs on the affected area can numb the ache. Additional non-drug treatment plans include acupuncture, spinal manipulation, and exercises such as swimming (Traeger et al., 2021). Combining these procedures may greatly aid in improving the patient’s injury.
If Mr. X’s injury is non-responsive to non-drug treatments, several medications may be suggested. The recommended prescriptions include acetaminophen to lessen severe back pain (Koes et al., 2020). In addition, the patient may use non-steroidal anti-inflammatory drugs (NSAIDs), specifically ibuprofen, to relieve his back ache (Koes et al., 2020). Nevertheless, NSAIDs may have adverse effects, including gastrointestinal bleeding and heart attack. The use of oral or intramuscular steroids is not advisable because it may increase the patient’s blood sugar (Shin et al., 2020). Therefore, the patient should report back in case of any adverse effects associated with the drugs.
Additional pharmacologic approaches suitable for severe back pain include the use of anti-depressants. In this case, duloxetine can help numb the patient’s backache (Traeger et al., 2021). Additionally, a muscle relaxant, particularly baclofen, may be prescribed on a short-term basis to relieve muscle spasms and lessen the pain. However, these relaxers may be addictive and pose multiple side effects, including fatigue, nausea, and grogginess. Similarly, the patient may directly apply topical analgesics such as menthol rubs, lidocaine patches, and capsaicin cream on their lower back to dampen the ache (Peck et al., 2020). These interventions may be effective in managing the patient’s injury.
Kinetics and Dynamics of Kava kava
Mr. X’s use of Kava Kava needs to be evaluated in the context of his acute diagnoses and medications. Kava is mostly used as a natural treatment for anxiety (Sarris et al., 2019). Once consumed, the active compounds are absorbed into the bloodstream through the gastrointestinal tract and then metabolized in the liver (Bian et al., 2020). The kavalactones are broken down into smaller components and excreted from the body through the urine. Nevertheless, Kava has adverse effects, including dizziness, allergic reactions, fatigue, and liver toxicity (Ballotin et al., 2021). It may interact with Coumadin, which the patient takes for DVT, increasing the risk of bleeding (Leite et al., 2021). Thus, it should be excluded from the patient’s treatment plan.
Kinetics and Dynamics of CoEnzyme Q10
The patient’s use of CoEnzyme Q10 should also be assessed. This supplement has cardiovascular benefits and no known interactions with metformin or Coumadin (Raizner, 2019). It acts as an antioxidant, safeguarding the cells from harm by free radicals. CoQ10 is a fat-soluble molecule that is absorbed through the small intestine, transported in the blood by lipoproteins, and distributed to all body tissues (Suárez-Rivero et al., 2021). It is found in high concentration in organs with more energy demands, such as the kidney, liver, and heart though smaller levels may be in muscles and other tissues.
The metabolism of CoEnzyme Q10 mainly occurs in the liver. It is primarily eliminated from the body through feces and bile. Nevertheless, smaller amounts of the drug may be excreted through the urine (Suárez-Rivero et al., 2021). The removal of CoQ10 from the body often depends on its rate of synthesis and breakdown. CoEnzyme Q10’s absorption, distribution, metabolism, and excretion can be influenced by certain health complications, age, and diet. The supplement’s side effects include abdominal pain, nausea, and loss of appetite (Raizner, 2019). Since it is unclear why the patient is using CoQ10, the drug should be omitted from the treatment plan.
Education Plan
The patient and his family need to be informed about using the recommended treatment interventions for pain management. In this case, the family can be advised to ensure that Mr. X takes the prescribed ibuprofen dosage to avoid adverse effects. Additionally, the patient’s family may be cautioned about the side effects of the prescribed drugs. For example, ibuprofen risks gastrointestinal bleeding and may react with Coumadin (Villa Zapata et al., 2020). Furthermore, Mr. X’s family should be directed on the importance of non-pharmacologic approaches, such as staying active, massage therapy, exercise, and spinal manipulation, in helping the patient manage his back pain. The information should be relayed in a manner that is empathetic and respectful to the patient and his family to encourage treatment compliance.
There is a need for patient education and guidance on appropriate medication management. Mr. X and his family should be made aware of any possible interactions between his drugs and the OTC products, particularly Kava Kava. They have to be notified that the recommended medications, such as acetaminophen, may react with Coumadin and cause bleeding. Emphasis needs to be made on reporting any adverse effects associated with the prescriptions. Additionally, the patient’s family should be cautioned against Mr. X’s use of new supplements without a healthcare provider’s approval to prevent further complications. Nevertheless, the patient and his family need to be allowed to seek clarification and the appropriate feedback provided.
A reminder should be made regarding the importance of effectively managing pre-existing conditions. Mr. X’s family needs to be notified about ensuring that he continues his metformin prescription, regularly monitors his glucose levels, and schedules frequent hospital check-ups to improve his diabetes (Quattrocchi et al., 2020). In addition, the family should be educated on the need to ensure that the patient maintains his Coumadin dosage and checks his INR levels repeatedly to manage his DVT complication. Active listening and providing critical leads can assist the patient in complying with the recommended treatment plan.
Recommendations should be made on the patient’s need for appropriate lifestyle modifications. In this case, the patient needs to be advised to quit smoking to avoid exacerbating his chronic pain and heightening his risk for cardiovascular complications. Similarly, Mr. X’s family should be guided to ensure the patient exercises regularly, maintains a healthy diet, and schedules frequent check-ups to help improve his general health outcomes (Koehler & Drenowatz, 2019). Exploring, acknowledgment, and reflection may assist the patient in adopting a healthy lifestyle. The patient and his family should also be educated on the essence of reporting any new symptoms or deterioration of his disorders or injury to guarantee effective treatment interventions.
Conclusion
Based on the presented symptoms, Mr. X suffers from lumbar muscle strain. The injury may have stemmed from his skiing accident ten years ago. The use of non-pharmacological interventions, including heat packs, massage therapy, staying active, acupuncture, spinal manipulation, and exercise, may help alleviate back stiffness and pain. The patient’s condition can also be managed through medications, such as acetaminophen, NSAIDs, anti-depressants, muscle relaxants, and topical analgesics. Nevertheless, some drugs may be addictive or pose adverse effects, including gastrointestinal bleeding. Additionally, the use of OTC products, such as Kava Kava, may interact with the patient’s prescriptions, particularly Coumadin, increasing the possibility of bleeding. The patient’s educational plan involves creating awareness of pain management and appropriate lifestyle modifications.