The motivation for use will help you determine if there is an addiction or whether the pain is being under managed.4. He is now at the emergency department (ED) with a suspected T5-T6 fracture with paraplegia. He saw a previous physician of whom he is critical.He is very happy with you, his new doctor: "You understand me so much better than Dr. Frank did. Case One: A Spinal Cord Injury Patient With a Pain Medication Problem. )If it is clear that there is significant clinical impairment in the patient's biopsychosocial functioning as a result of his Dilaudid use, the patient should be referred to a substance abuse treatment provider for further evaluation and treatment. She didn't want to hear about it. and "Do you ever take anyone else's pills?" Would you consider taking another medication to manage your pain?n. Provider Orders: ⎯ Insert Foley catheter ⎯ ECG monitoring ⎯ Immobilize the cervical spine … Ask the following questions:l. Do you have arguments with people in your life regarding your behavior when you are taking Dilaudid?m. Would you consider approaches other than medication for managing your pain?If the person becomes resistant or uncooperative try to reassure the patient that you are gathering this information to provide the best care for his health. Lack of treatment availability (affordability, waiting-lists, services not available in community).8. Physician's family history causes countertransference (misperceptions based on personal experiences). He sustained a vertebral fracture and complete spinal cord injury at T7. ")(The goal is to determine when, how often, and under what kind of stress/pain conditions is the patient using/abusing the prescribed medications or other drugs.

If you suspect the patient is minimizing or omitting other sources of medication, do a search on the Utah State Controlled Substance Database (csdb.utah.gov). (Note: It is important to ask specifically about pills, as many people do not consider pills to be drugs of abuse.)

This patient is specifically requesting Dilaudid and indicating that this is the only medication that can work.

Or ask specifically about certain drugs such as "tell me about your marijuana use. If the patient remains resistant then ask them what they would like to do and consider whether it is an appropriate request.1.

Belief that he couldn't possibly be in this much pain.3. Mr. Hansen is a 27-year-old male with pain secondary to a T-12 spinal cord injury resulting in paraplegia. Students read the short case scenario, which provides a brief clinical history of the patient and a description of his injury, then answer a set of directed questions designed to probe the students’ … Review the patient's medication use to look for interactions or contraindications in a patient who is using Dilaudid.2. NOTE: The files listed above are PDF Files, so you will need to have Adobe Reader on you system. Traumatic spinal cord injuries is a devastating event that often leads to significant long-term neurological morbidity. Every trauma patient is unique in terms of the mechanism of injury, individual … Names of patients, physicians, health related professionals, hospitals, locations and all other identifying information have been changed. Belief that treating pain among people with addictions will exacerbate their addiction.5. This level of specificity may indicate abuse of medication.2. She didn't care that I'm in pain. Belief that treating pain with opioids will cause an addiction.6. You're the only one who really understands what is going on. Case Four: A Patient With an Oxycontin Addiction.

The physician needs to be aware of the internal/external stigma and biases that the patient faces. An addiction (according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV)) is defined by the biopsychosocial consequences of use, not just frequency and amount. It is traditional in the medical, rehabilitation and psychological fields to use case studies for learning purposes and it is in that tradition that these case studies are being utilized. Belief that people with addictions don't deserve to be treated for their pain.4. It is easier and quicker to just fill the prescription rather than assess for pain and addiction.7. If currently using alcohol or illegal drugs, ask questions as noted in section B. Spinal Cord Injury – Case Study. Such as "Do you ever take any other kind of pills?" Spinal Cord Injury Sample Case Spinal Cord Injury Case Report (PDF File) Spinal Cord Case Vocational Worksheet (PDF File) Spinal Cord Case Sample Life Care Plan (PDF File) Spinal Cord Case Sample Life … (Reminder: Do not use the term "illegal drug". Case Two: A Traumatic Brain Injury Patient With a History of Heroin & Alcohol Use. The potential overuse of Dilaudid in this patient should raise concern of liver toxicity and drug tolerance.3. (The goal is to develop a positive, non-judgemental rapport with the patient? Physician's discomfort with addressing substance abuse issues.10. )(The goal is to gather relevant history and barrier information.)1.

Review medications from any other prescriber.

He refuses to consider any other medication and claims he doesn't have time to go to physical therapy. Case …


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