Why we agree that patients at high risk of developing CHD should be referred to Cardiac
Please make note- it should be specifically related to this topic only. No introduction or
conclusion needed. 4 Apa references not old then 5 years old. journals and articles only
Intervention towards Management of Back Pain
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 condition is also prevalent within the healthcare professionals where nurses have a
higher likelihood of developing back pains unlike individuals from other professions
(Buchbinder et al., 2013). 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 (Dima, 2013, e490).
In the event that self management of back pain is recommended, especially after an
operation, patient education is paramount as records show that chronic back pain must be
eventual impact of such (Blizzard, 2016, p19). An appropriate example where this cannot apply
and medical attention is a must is the case of back pain related to spinal stenosis, and
degeneration of the left hip (Blizzard, 2016, p19). The authors explain that after a total hip
arthroplasty, which according to a follow up done causes a degeneration of lumbar spine and
consequential stenosis, patients experience back pain plus other disabling symptoms (Blizzard,
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. In connection to these arguments, the following is an
investigation into a clinical intervention that is expected in clinical physiotherapy for a patient
called John, who is reported to be experiencing chronic back pain; encompassing the role of a
nurse in the same. The intervention is a multimodal intervention of chronic back pain involving
nutrition and dietetics, pharmacology, psychological and physical fitness measures. In this case
study 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.
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 (Silisteanu, 2015, p1). 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). 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.
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
massageaids in reduction of muscle spasms, reducing damming, and improve blood circulation.
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 nurse updated about his
feelings so that the nurse 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;
i) 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).
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, whichthe
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. Furthermore, the nurse will encourage John to switch activities between sitting, lying
or walking for a long time. In summary, there is a specific exercise and posture education that is
imparted by a nurse to a patient visiting a clinic for back pain management.
To summarize, therapeutic intervention of chronic back pain can be applied both patient’s
with unspecific conditions, and to those in which the condition is secondary implication of a
medical procedure such as surgery. The aspects of this nurse intervention will include patient
education, nutrition and weight loss, pain alleviation and psychological assessment of the pain to
check for depression. In order to encourage correct self-management of the chronic back pain,
expert advice on adherence to medications given and important exercise techniques is offered.
This can be named as a multimodal intervention of chronic back pain involving nutrition and
dietetics, pharmacology, psychological and physical fitness measures.
To conclude back pain is a common health problem in Australia. 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.
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 Cartilage, 24, S10-S11.
Blizzard, D. J., Nickel, B. T., Seyler, T. M., & Bolognesi, M. P. (2016). The Impact of Lumbar
Spine Disease and Deformity on Total Hip Arthroplasty Outcomes. Orthopedic Clinics of
North America, 47(1), 19-28.
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
Rheumatology, 27(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
Physician, 15, 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
reports, 15(12), 1-8.
Dima, A., Lewith, G. T., Little, P., Moss-Morris, R., Foster, N. E., & Bishop, F. L. (2013).
Identifying patients’ beliefs about treatments for chronic low back pain in primary care: a
focus group study. Br J Gen Pract, 63(612), e490-e498.