Back Pain

The purpose of this essay is for students to present a comprehensive discussion and justification identifying two (2) care priorities within a clinical scenario using the Levett-Jones Clinical Reasoning Cycle.

Back Pain

Introduction

Back pain is a common and costly disorder in Australia. Hoy et al., (2014) report that about 25% of Australians suffer from back pain and approximately half of them seek medical attention. The direct costs for treatment of this condition in Australia have been estimated to be approximately $ 1 billion with an addition of $ 8 used in indirect costs (Buchbinder et al., 2013). The condition is also prevalent within the healthcare professionals where nurses have a higher likelihood of developing back pains unlike individuals from other professions. In South Australia alone, back injury accounts for over $2 million in every financial year (Lorig et al., 2013). Surveys of patient self-managing their back pain as well as those managed in primary care have indicated that usual care is not often evidence based hence hindering provision of best outcomes to patients. Consequently, there has been a growing demand to address the ramifications of back pain through changes in health policies, investments, and service delivery. Healthcare providers, are charged with the responsibility of ensuring that patients receive effective prevention and treatment strategies to curb this menace.

There are a number of activities that a nurse will conduct to examine John’s condition and the proper intervention that he needs for effective management of his condition. Some of these activities that the clinician will examine include;

Patient Education

In the initial visit, the nurse will educate John on chronic back pain by highlighting clearly that the condition may arise due to an injury or diseases on different body structures such as the muscles, joints, ligaments, or nerves. According to Traeger et al., (2014), the type of pain varies and can be felt as muscle pain, bone pain, or nerve pain. The nurse will also emphasize that it is important for patients to seek medical attention the moment they have back pains and not wait until the disorder worsens to promote effective management of the condition. At this point, it will be of great significance for the nurse to let John know that he is not the only one suffering from back pain. He should understand that back pain is a massive problem in Australia that sends more people to seek medical attention more than any other condition except common cold (Driscoll et al., 2014).

Nutrition and Weight loss

Normally, patients who are overweight, such as John, and suffer from back pain, may not be aware their excess weight aggravates their condition (Brady et al., 2016). It is well known that obese patients are at a greater risk for back pain, muscle strain, and joint pain unlike those that are not overweight. Moreover, obese patients also complain of fatigue and shortness of breath which makes them refrain from exercises worsening their back pain (Heuch et al., 2013). When patients do not get enough exercise for quite some time, the back’s supporting structures become weak, stiff, and deconditioned which further increases pain (Silisteanu & Covasa, 2015, November). It is for these reasons that the clinician will encourage John to have a weight loss program which may involve gentle low-impact activities such as walking, jogging, or water therapy. The clinician will also advise John to avoid eating foods with high fat content. He should also stick to a rational nutrition plan which involves changes in eating habits as a step toward effective management of his back pain.

During the visit, the healthcare provider will observe John’s posture and position. Reviewing of John’s curvature of the spine, shoulder symmetry, and the iliac crest will also be of great importance. The healthcare provider will conduct a physical examination through palpation of John’s paraspinal muscle to identify any form of tenderness and then initiate proper interventions as per the findings.

Pain Alleviation

For pain reduction, the healthcare provider will encourage John to take timed bed rests and adjust his position to improve flexion of the lumbar region. The nurse will teach him to regulate and adjust the pains that traverse through the respiratory diaphragm. Relaxation can also help in reducing muscle tension that contributes to back pain. John should also adjust his sitting position regularly or even engage in other activities such as reading books, watching a movie or take part in yoga. The nurse will advise John to request his wife, Donna, to gently massage his back. It has been proven by Kumar, Beaton & Hughes, 2013; Schulz et al., 2014) that massage aids in reduction of muscle spasms, reducing damming, and improve blood circulation.

Depression

Depression is the most common emotion linked to chronic back pain. Patients with chronic back pain have major depression which is said to be four times greater in such patients than in the general public in Australia. John is not an exception from this statistics since he reports that he is depressed because he can no longer take part in activities such as hiking and cycling that he has always loved. Research has revealed that depression can trigger back pain (Steffens et al., 2012). It affects the intensity, frequency and the rate of healing of back pain. Consequently, the nurse will advise John to communicate about the depression. Mostly, many patients do not talk to their physicians about their depression, anxiety, or stress (Center, 2012). Individuals that are stressed tend to tense their back muscles which in turn trigger the onset of low back pain or make it even worse. They believe that the emotions will go away once the initial pain problem is solved. Therefore, John should regularly keep me updated about his feelings so that I may provide desirable care to him. The nurse will also recommend John to interact with other people, for instance, he can occasionally visiting his daughter or son or play with his grandchild to avoid being lonely and stressed up.

The two activities that the nurse will give priority in the subsequent visits are;

  1. Adherence to Medication

Generally, healthcare providers are aware of the considerable increase in rates of opioid prescribing. Opioids have long been used as pain management agents. However, they are associated with adverse reactions such as nausea, vomiting, constipation, respiratory depression, addiction, and even death. The side effects usually limit their use by patients. Therefore, in the first visit and subsequent visits, this is an issue the nurse will be reviewing. In these visits, the clinician will assess the effectiveness of the prescribed analgesics and inquire from John on whether what he feels after taking the drug. The clinician will then initiate appropriate adjustments according to the patient’s condition for effective pain management. Besides, other pain management therapies such as acupuncture, yoga, chiropractic care, and herbal medicines such as ginger, capsaicin and feverfew can be used (Ferreira et al., 2014).

ii)  Exercise

According to Searle et al., (2015)exercise should be the first treatment choice for a patient with back problems such as John. This is because exercise matches the fact that individuals with chronic back pain should be physically active and involve themselves in their management. Moreover, treatments such as massage, acupuncture, and manipulative therapy are passive hence the patient is not involved in the therapy. Falla et al., (2014) further highlight that exercise provides other health benefits beyond back pain management, for instance, in terms of bone and cardiovascular health. Therefore, the nurse will encourage John to take part in usually low grade oscillatory exercises such as knees side to side rotation, knee to chest stretches, pelvic tilts, and press ups. The nurse will also help John to come up with an exercise program which the nurse will be supervising to ensure he follows it.

 There are several forms of exercise and there is no genuine reason of expecting that one approach would be better than the other (O’Sullivan, 2012; Elden et al, 2013).  As a result, the nurse will give John a list of beneficial exercises he can engage in and enquire from him which type he would prefer so that it is included in the exercise program. The best form of exercise for any patient is the one they are enthusiastic about and willing to continue with. For instance, John says he likes cycling; an activity that has been recorded to have desirable outcomes in patients with back pains. This can be included in his program. The healthcare provider will advise John not to take part in heavy physical activities, circular motions, and sways which often worsen the condition. The nurse will encourage John to switch activities while sitting, lying or walking for a long time.

Conclusion

Back pain is a common health problem in Australia (Cramer et al., 2013). However, its prevalence can be reduced significantly if patients and clinicians work together. Patients, for instance, should seek early medical attention and adhere to the prescribed medications and the recommended activities. On the other hand, physicians should keep a close surveillance on these patients and ensure that desirable patient outcomes are realized.

References

Brady, S. R., Hussain, S., Brown, W. J., Heritier, S., Billah, B., Wang, Y., & Cicuttini, F. M. (2016). Relationships between weight, physical activity and back pain in young adult women. Osteoarthritis and Cartilage24, S10-S11.

Buchbinder, R., Blyth, F. M., March, L. M., Brooks, P., Woolf, A. D., & Hoy, D. G. (2013). Placing the global burden of low back pain in context. Best Practice & Research Clinical Rheumatology27(5), 575-589.

Center, C., Relief, P., Covington, L. A., & Parr, A. T. (2012). Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician15, E159-E198.

Cramer, H., Lauche, R., Haller, H., & Dobos, G. (2013). A systematic review and meta-analysis of yoga for low back pain. The Clinical journal of pain, 29(5), 450-460.

Depression Goesling, J., Clauw, D. J., & Hassett, A. L. (2013). Pain and depression: an integrative review of neurobiological and psychological factors. Current psychiatry reports15(12), 1-8.

Driscoll, T., Jacklyn, G., Orchard, J., Passmore, E., Vos, T., Freedman, G., & Punnett, L. (2014). The global burden of occupationally related low back pain: estimates from the Global Burden of Disease 2010 study. Annals of the rheumatic diseases, annrheumdis-2013.

Elden, H., Gutke, A., Kjellby-Wendt, G., Fagevik Olsén, M., Stankovic, N., & Östgaard, H. C. (2013). Back pain in relation to pregnancy: A longitudinal 10-year follow-up of 369 women diagnosed with pelvic girdle pain during pregnancy. In Advances in multidisciplinary research for better spinal/pelvic care. The 8th Interdiciplinary World Congress on Low Back & Pelvic Pain, Oct, 2013. Dubai.

Falla, D., Gizzi, L., Tschapek, M., Erlenwein, J., & Petzke, F. (2014). Reduced task-induced variations in the distribution of activity across back muscle regions in individuals with low back pain. PAIN®155(5), 944-953.

Ferreira, P. H., Ferreira, M. L., Maher, C. G., Refshauge, K. M., Latimer, J., & Adams, R. D. (2013). The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Physical therapy93(4), 470-478.

Heuch, I., Heuch, I., Hagen, K., & Zwart, J. A. (2013). Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trøndelag Health Study. Spine38(2), 133-139.

Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., & Murray, C. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Annals of the rheumatic diseases, annrheumdis-2013.

 Kumar, S., Beaton, K., & Hughes, T. (2013). The effectiveness of massage therapy for the treatment of nonspecific low back pain: a systematic review of systematic reviews. Int J Gen Med6, 733-741.

Lorig, K., Ritter, P. L., Plant, K., Laurent, D. D., Kelly, P., & Rowe, S. (2013). The South Australia health chronic disease self-management Internet trial. Health Education & Behavior40(1), 67-77.

O’Sullivan, P. (2012). It’s time for change with the management of non-specific chronic low back pain. British journal of sports medicine46(4), 224-227.

Schulz, C., Leininger, B., Evans, R., Vavrek, D., Peterson, D., Haas, M., & Bronfort, G. (2014). Spinal manipulation and exercise for low back pain in adolescents: study protocol for a randomized controlled trial. Chiropractic & manual therapies22(1), 1.

Searle, A., Spink, M., Ho, A., & Chuter, V. (2015). Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clinical rehabilitation29(12), 1155-1167.

Silisteanu, S. C., & Covasa, M. (2015, November). Reduction of body weight through nutrition intervention reduces chronic low back pain. In E-Health and Bioengineering Conference (EHB), 2015 (pp. 1-3). IEEE.

Steffens, D., Ferreira, M. L., Maher, C. G., Latimer, J., Koes, B. W., Blyth, F. M., & Ferreira, P. H. (2012). Triggers for an episode of sudden onset low back pain: study protocol. BMC musculoskeletal disorders13(1), 7.

Tekur, P., Nagarathna, R., Chametcha, S., Hankey, A., & Nagendra, H. R. (2012). A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: an RCT.Complementary therapies in medicine20(3), 107-118.

Traeger, A. C., Moseley, G. L., Hübscher, M., Lee, H., Skinner, I. W., Nicholas, M. K., & Hush, J. M. (2014). Pain education to prevent chronic low back pain: a study protocol for a randomised controlled trial. BMJ open,4(6), e005505.

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