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Optimising care in chronic condition - Back Pain
Name of the writer
Name of the institution
Part A
Low Back pain can be uncomfortable and debilitating. Low back pain is responsible behind absence from the work due to the intensity of pain, with a quarter of Australians having the human back is comprised of muscles, disks, bones, ligaments, and tendons. Problem with any of these components results in severe low back pain. It is notable to mention that damage can result from medical conditions, poor postures, or strain. The high-risk factors that are somehow responsible to develop low back pain include pregnancy, poor physical fitness, occupational activities, older age, smoking, obesity, medical conditions and genetic factors. Low back pain is common in women than men. Individuals with low back pain (LBP) have greater difficulties to manage their routine life in a positive manner. In Australia, A4.9 billion is the costs for managing back problems. It is noteworthy to mention that approximately A220 million was reimbursed by Medicare for spinal imaging (Aci.health.nsw.gov.au). A large amount of money could have been avoided with the help of National guidelines for LBP. An appropriate model of care is required for effective management of low back pain.
According to the South Western Sydney Local Health District (SWSLHD), there are some key areas in order to cope with low back pain. These areas include better use of appropriate analgesia, radiological imaging if necessary, application of more appropriate clinical examination, and enhanced patient education. The basic standard care plan in accordance with SWSLHD includes assessment of history and physical examination of the patient, not referencing a patient with chronic LBP for imaging, health education illustrating self-management approaches and contemporary treatment, and LBP management in accordance with evidence-based practice guideline. The model of care for LBP should include health care practitioners, practice nurse, and physiotherapist with the primary team members being patients and their guardians. A systematic and formal history and examination of the patient is acquired in order to identify the pathway of health care. The amount and type of treatment patients require is assessed with the help of prognostic risk stratification (Australian Institute of Health and Welfare). Basic education about self-management is given to ensure that the patient is aware of the benefits of self-management. The guideline recommends that the patient should avoid bed rest and needs to remain active. Active physical therapy helps to improve the physical fitness of the patient, which proved to be very effective. A properly structured exercise program is the main focus of physical therapy. In order to minimize the pain, regular paracetamol such as simple analgesic medicines are effective. Evidence shows the efficiency of cognitive behavioral therapy to improve outcomes for people with LBP. Non-Steroidal anti-inflammatory drugs (NSAIDs) are recommended to reduce the pain for the short term. According to the outline of the South Western Sydney Local Health District, it is recommended to review each individuals progress after six and twelve weeks.
Part B
Jean is a 55-year old Indigenous woman who is living in an area in Sydney South West Local Health District. She was diagnosed with low back pain in the past and now, she is experiencing the exacerbation of its symptoms. Her low back pain can be effectively managed in primary care, but she is little afraid about the current environment in Sydney South West Local Health District where everyone is in a hurry. There is an immense need to mitigate her fear in order to provide her with effective health care services. Following steps are essential for the proper model of care.
Assessment History and Examination
The initial assessment of Jean indicates that she was diagnosed with low back pain in the past and up till now she had not suffered from back pain. However, in the last few weeks, the symptoms again begin to exacerbate. All the previous investigations are reviewed to determine the history of low back pain. It is notable to mention that the majority of hospitals in the south-west Sydney urge people for imaging. However, according to the standards and policies of South West Sydney Local Health District, there is no need for imaging in majority of the cases with LBP. It is important in the first consultation to provide health education to Jean. Healthcare practitioner needs to reassure and explain to her that back pain is a symptom. Staying active is the key to control low back pain (Briggs and Buchbinder, 2009, pp.501). Jean is recommended to do perform daily activities as it will lead to the most rapid and complete recovery. Being active and staying at work helps to minimize the risk of recurrent problems (Bogduk, 2004, pp.81). Health care practitioner needs to motivate patient to perform daily activities as backache is not going to cripple a person unless a person let it. Jean is afraid about the attitude and behavior of medical staff in the hospital, so it is necessary to use effective communication to make her feel comfortable in the hospital environment. It is effective to use a language that promotes a bio-psychosocial approach to pain. In order to encourage patient for normal activity and movement, healthcare practitioners need to use words like Motion is lotion or you back get stronger with movement. Use of such words will encourage her to practice what is suggested by doctors.
Non-opioid analgesics
The first line option for Jean is non-opioid analgesics such as acetaminophen. It is necessary to reevaluate jean on a monthly basis to assess the efficacy of current regimes. The follow-up visits are compulsory to perform therapeutic modifications (Maher et al., 2017, pp.743). These visits will help to assess the changes in functioning and pain severity along with analgesic efficacy and safety. Time-contingent dosing is recommended for Jean as it is best, to begin with simple analgesics. After the consideration of adverse reactions, Non-steroidal anti-inflammatory medications are effective to use in order to get rid of the pain for short time-frames (Glazov, Yelland and Emery, 2016, pp.233). Non-steroidal anti-inflammatory medications are well known for their antipyretic and anti-inflammatory reactions (Buchbinder et al., 2018, pp.2385). Furthermore, by keeping in mind the weight gain and severe pain, it is recommended for Jean to start taking Panadol regularly throughout the day along with other medications (Shaheed et al., 2016, pp.206). Intake of Panadol will help in reducing the pain.
Physiotherapy
It is notable to mention that exercise is efficient for chronic low back pain in comparison to medications. The physiotherapist helps patients with physical difficulties or pain to improve their movement. It is recommended to provide the services of a physiotherapist to Jean to develop a proper exercise plan to improve the quality of life. Exercise programs like posture re-training and muscle strengthening are beneficial for Jean to reduce low back pain (Shipton, 2018, pp.129). Accurate extending of the muscles along with energetic workout are effective to provide relief for muscles to sustain a standard range of motion (Qaseem et al., 2017, pp.514). According to the recommendations of the physiotherapist, Jean should emphasis on stretching the muscles of legs, hips, and lower back. The physiotherapist needs to ensure that all stretches must need to be steady and gentle. Abrupt and extensive stretches are catastrophic for the health of the individual as they often result in high pain (Synnott et al., 2016, pp.217). Normal sit-ups and leg raises are also effective to make Jean physically active. The physical therapy program for Jean is effectively focused on active exercises such as stretching and normal sit-ups. Regardless of managing back pain, exercise is likely to provide health benefits in terms of bone health and cardiovascular (Koch, Jenkin and Kralik, 2013, pp.292). Supervised exercises are more effective for Jean. It is the core responsibility of Jean to participate in the physical therapy program to promote better health.
Interdisciplinary Rehabilitation
There is an immense need for interdisciplinary rehabilitation for Jean. Different health care professionals from various fields will help together in order to improve the ability of a patient to mitigate severe pain. Interdisciplinary rehabilitation will help Jean to improve its social and vocational participation as it promotes physical activeness. Jeans family also needs to be involved in the rehabilitation process to make the process effective. Interdisciplinary rehabilitation is essential for Jean to manage her low back pain (Maher et al., 2011, pp.128). This is an effective program for Jean and should be organized from 9am to 1pm Monday to Friday for the first three weeks. A final half-day review at two and six months is essential to assess the progress and efficiency of this program.
Proper Diet
According to the South Western Sydney Local Health District standards, the adequate diet plan is useful to decrease the signs of low back pain as it can be debilitating, thus impacts the overall lifestyle. Magnesium rich foods such as avocados, green leafy vegetables, bananas, cultured dairy, and coconut water have a positive effect on patients day to day lifestyle. Foods high in fiber are also beneficial for Jean to minimize the symptoms of low back pain. It is recommended for Jean to eat plenty of high fiber foods such as vegetables and fruits to improve the digestion (Matthews et al., 2018, pp.36). Effective digestion will help Jean to control her weight in an effective manner. Researchers have found that Omega 3 fats are favorable to manage back pain due to the reduction in inflammation (Lin et al., 2017, pp.2078). It is also recommended for Jean to consume lean protein foods such as grass-fed meats or pasture-raised chicken. These lean protein foods provide sufficient nutrients to the body that helps in maintaining muscle and bone health. Tobacco smoking is harmful for the health of Jean as it can cause cancer (Chris, 2019). Jean is addictive to cigarettes which is catastrophic for her health. The indications of back pain are exacerbating in Jean due to the extensive consumption of cigarettes. According to researchers, the underlying cause of low back pain also includes cancer (Henderson et al., 2013, pp.1352). Therefore, it is evident that Jeans worse health conditions are due to the over-consumption of smoking. It is recommended for Jean to stop smoking in order to promote a better lifestyle. Jean needs to stock up oral substitutes such as carrot sticks, coffee stirrers, hard candy, and sugarless gum to keep herself distracted from a cigarette (Koes et al., 2013, pp.2076). Non-nicotine medications are also effective to combat the habit of smokers quit. As it is hard for Jean to quit smoking immediately, so she needs to take two prescribed non-nicotine medications including varenicline (Chantix) and bupropion (Zyban).
Conclusion
In a nutshell, low back pain is a severe issue that contributes significantly to morbidity. The effective care plan is necessary to help the patient to improve the health. Evidence-based studies indicate that an adequate pain management plan is required to reduce the low back pain. Using non-opioid analgesics along with certain anti-inflammatory medications are useful to reduce the severe symptoms of low back pain. Physiotherapy helps towards physical activeness of a person and it allows a person to manage pain. Gradual exercises and stretching are useful to reduce the symptoms of low back pain as they are beneficial for bone density. Use of magnesium-rich foods and omega 3 fats also compulsory to mitigate low back pain.
References
Aci.health.nsw.gov.au. (2019). online Available at https//www.aci.health.nsw.gov.au/__data/assets/pdf_file/0007/336688/acute-low-back-pain-moc.pdf Accessed 23 Apr. 2019.
Australian Institute of Health and Welfare. (2018).Back problems snapshot, About back problems and associated comorbidities - Australian Institute of Health and Welfare. online Available at https//www.aihw.gov.au/reports/arthritis-other-musculoskeletal-conditions/back-problems/about-back-problems-and-associated-comorbidities Accessed 23 Apr. 2019.
Bogduk, N., 2004. Management of chronic low back pain.Medical journal of Australia,180(2), pp.79-83.
Briggs, A.M. and Buchbinder, R., 2009. Back pain a national health priority area in Australia.Medical Journal of Australia,190(9), pp.499-502.
Buchbinder, R., van Tulder, M., berg, B., Costa, L.M., Woolf, A., Schoene, M., Croft, P., Hartvigsen, J., Cherkin, D., Foster, N.E. and Maher, C.G., 2018. Low back pain a call for action.The Lancet,391(10137), pp.2384-2388.
Chris, Mehar. (2019).Managing low back pain in primary care. online Available at https//www.nps.org.au/australian-prescriber/articles/managing-low-back-pain-in-primary-carer1 Accessed 23 Apr. 2019.
Glazov, G., Yelland, M. and Emery, J., 2016. Low-level laser therapy for chronic non-specific low back pain a meta-analysis of randomised controlled trials.Acupuncture in Medicine,34(5), pp.328-341.
Henderson, J.V., Harrison, C.M., Britt, H.C., Bayram, C.F. and Miller, G.C., 2013. Prevalence, causes, severity, impact, and management of chronic pain in Australian general practice patients.Pain Medicine,14(9), pp.1346-1361.
Koch, T., Jenkin, P. and Kralik, D., 2004. Chronic illness self management locating the self .Journal of advanced nursing,48(5), pp.484-492.
Koes, B.W., van Tulder, M., Lin, C.W.C., Macedo, L.G., McAuley, J. and Maher, C., 2010. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care.European Spine Journal,19(12), pp.2075-2094.
Lin, I.B., Ryder, K., Coffin, J., Green, C., Dalgety, E., Scott, B., Straker, L.M., Smith, A.J. and OSullivan, P.B., 2017. Addressing disparities in low back pain care by developing culturally appropriate information for aboriginal australiansMy Back on Track, My Future.Pain Medicine,18(11), pp.2070-2080.
Maher, C., Underwood, M. and Buchbinder, R., 2017. Non-specific low back pain.The Lancet,389(10070), pp.736-747.
Maher, C.G., Williams, C., Lin, C. and Latimer, J., 2011. Managing low back pain in primary care.Aust Prescr,34(5), pp.128-32.
Matthews, M.L., Wooding, F.G. and Folta, A.Q., 2008. Management of Chronic Low Back Pain.US PHARMACIST,33(5), p.34.
Qaseem, A., Wilt, T., McLean, R. and Forciea, M. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain A Clinical Practice Guideline From the American College of Physicians.Annals of Internal Medicine, 166(7), p.514.
Shaheed, C.A., Maher, C.G., Williams, K.A., Day, R. and McLachlan, A.J., 2016. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain a systematic review and meta-analysis.JAMA internal medicine,176(7), pp.958-968.
Shipton, E. (2018). Physical Therapy Approaches in the Treatment of Low Back Pain.Pain and Therapy, 7(2), pp.127-137.
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Synnott, A., OKeeffe, M., Bunzli, S., Dankaerts, W., OSullivan, P., Robinson, K. and OSullivan, K., 2016. Physiotherapists report improved understanding of and attitude toward the cognitive, psychological and social dimensions of chronic low back pain after Cognitive Functional Therapy training a qualitative study.Journal of physiotherapy,62(4), pp.215-221.
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