In case the patient is already receiving epidural injections and has some medication prescribed, it would be impossible to proceed with any intervention that has been planned initially. The reason for such a decision is that it is necessary to find out what drugs and in what dosage the patient is taking in order to eliminate the possibility of adverse outcomes. Moreover, it may turn out that no additional medications are needed, and that The patient is receiving the sufficient amount of them. Still, failure to manage the patient’s pain is considered as “unethical, poor clinical practice” (Schaffler, 2016, p. 1351). Thus, it is necessary to make sure that the patient is provided with the most qualified help.
Another pharmacological option that might be offered to the patient is adjuvant analgesics. Although this type of drugs is not commonly used for pain management, it can successfully help to control pain in some cases (Schaffler, 2016). Corticosteroids are particularly relevant to the patient’s problem since they are reported to relieve the inflammation discomfort. Such drugs as dexamethasone and prednisone can play a beneficial role in the patient’s treatment.
However, since he has a medical history of an ulcer, these medications can only be prescribed for a short term in order to avoid the risk of gastrointestinal bleeding. Other side effects of adjuvant analgesics’ chronic use include thromboembolism and adrenal suppression (Schaffler, 2016). Thus, adjuvant analgesics can produce a positive result, but they should be prescribed cautiously.
One more pharmacological option for the patient is the use of tricyclic antidepressants (TCSa) and serotonin and norepinephrine reuptake inhibitors (SNRIs). These drugs can help in managing the patient’s anxiety and depression (Schaffler, 2016). In particular, TCAs can be used for neuropathic pain, but they should be prescribed for a period of six weeks to reach the positive effect. These medicines are likely to help The patient since they are recommended for young patients rather than elderly individuals.
Apart from pharmacological treatment, there are some effective non-pharmacological options that could be recommended to the patient. The most viable of such solutions is the introduction of lifestyle modifications (Schaffler, 2016). To reduce the patient’s pain, it is possible to create a plan of exercises that could help the patient to lead a more comfortable lifestyle. Another issue that should be taken into consideration is the person’s weight (Schaffler, 2016).
In case the patient is prone to obesity, it is crucial to encourage him to lose weight, which will lead to less pressure on his skeleton and muscles. Physical functioning can also be enhanced by rehabilitative methods such as occupational or physical therapy, massage, and ice or heat therapy (Schaffler, 2016). These lifestyle modifications do not require much time and effort, but they have the potential for improving the patient’s health.
Another non-pharmacological approach is represented by cognitive-behavioral (CB) interventions. CB therapy is considered as the first-line psychosocial treatment for people suffering from chronic pain (Ehde, Dillworth, & Turner, 2014). Particularly, CB therapy is reported to have a positive effect on chronic back pain. CB interventions can be of two types: the ones not requiring a specialist and the ones demanding a professional (Schaffler, 2016).
Independent measures include meditation, relaxation techniques, muscle relaxation exercises, imagery, and others. Interventions involving a specialist comprise hypnosis, counseling, and biofeedback (Schaffler, 2016). An important role in the process of such treatment belongs to the patient’s family. Close people can encourage the patient to visit his practitioner and do exercises regularly.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. American Psychologist, 69(2), 153-166.
Schaffler, R. L. (2016). Pain management: Acute and chronic pain. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.) (pp. 1351-1372). Philadelphia, PA: F. A. Davis Company.