What would you do first prior to prescribing any medication?

Discussion 1 Before prescribing any medication, it is important to obtain a thorough history and physical exam of the patient. In this case, it would be important to assess the location, duration, and severity of the pain, as well as any exacerbating or relieving factors. It would also be important to assess any previous treatments for the pain, including any medication use and response.

The various schedules of medications for controlled substances are:

• Schedule I: These are substances with no accepted medical use and high potential for abuse, such as heroin and LSD.
• Schedule II: These are substances with high potential for abuse and dependence, such as oxycodone and fentanyl.
• Schedule III: These are substances with moderate to low potential for abuse and dependence, such as codeine and anabolic steroids.
• Schedule IV: These are substances with low potential for abuse and dependence, such as alprazolam and lorazepam.
• Schedule V: These are substances with the lowest potential for abuse and dependence, such as cough suppressants with codeine.

In this case, prescribing a long-acting narcotic may be more appropriate, as it would provide sustained pain relief and potentially decrease the need for frequent dosing. However, the decision to prescribe any narcotic should be made with caution, as there is a high potential for abuse and dependence.

Discussion 2 Other non-narcotic medication options that could be offered to this patient include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. It would also be important to consider non-pharmacological interventions such as physical therapy, massage, and heat or cold therapy.

Patient education regarding the safe use of these medications is essential. Acetaminophen has a maximum daily dose of 4 grams, and NSAIDs can cause gastrointestinal bleeding and kidney damage when used in high doses or for prolonged periods of time. Patients should be instructed to use these medications as directed and to avoid combining them with other pain medications or alcohol.

If the patient and his wife state that none of the non-narcotic options work for him, it would be important to reassess the patient and consider referral to a pain specialist. The patient’s history and response to previous treatments should be thoroughly evaluated before considering any further narcotic therapy.