Patient Demographics, Complaints, and Key Concepts Related to the Topic
A patient with chronic back pain will be used for the signature assignment. D.N., a 65-year-old Asian male born on 10 July 1958, came to the facility accompanied by his wife. He is under medical insurance coverage, and he is married. He seemed to provide a reliable and good history. He presented with lower back pain complaints that have been there for three years.
Chronic low back pain (CLBP) is a prevalent and incapacitating condition. The condition is characterized as chronic lower back discomfort lasting at least 12 weeks. The treatment of chronic low back pain often involves the utilization of Acupuncture and pharmacotherapeutics. The techniques, strategies, and philosophies employed by these entities exhibit variations.
Acupuncture entails the insertion of tiny needles into certain anatomical locations on the body. According to the principles of Traditional Chinese Medicine (TCM), it is posited that the flow of “Qi,” which refers to vital energy, occurs inside specific pathways known as meridians. Pain and sickness can be attributed to imbalances and blockages in the flow of Qi. It is a therapeutic technique that involves the stimulation of specific meridians to restore equilibrium to the flow of Qi. Contemporary theories suggest that Acupuncture’s release of endorphins and neurotransmitters may alleviate pain (Wu et al., 2021). The diagnosis and treatment of persistent low back pain by Acupuncture involve the comprehensive consideration of physical, emotional, and environmental factors.
Conversely, pharmacotherapeutics is a therapeutic approach to address persistent low back pain symptoms, including discomfort and inflammation. These pharmaceutical substances can decrease inflammation, impede the transmission of pain signals, and alter the experience of pain. Pharmacotherapeutics affect pain perception by targeting pain pathways, nerve receptors, and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, opioids, antidepressants, anticonvulsants, and topical medications are commonly utilized to manage chronic low back pain. Each group employs distinct approaches to addressing pain (Schreijenberg et al., 2019). Medication selection is determined by various factors, including the intensity of pain experienced, the underlying causes, the individual’s medical history, and the potential adverse effects of the prescription. The implementation of personalized treatment approaches is prevalent. Pharmacotherapeutics may offer only temporary relief due to adverse effects, the development of tolerance, and the potential for dependency (Tagliaferri et al., 2020).
The selection between Acupuncture and pharmacotherapeutics for the treatment of persistent low back pain is contingent upon various factors, including the patient’s preferences, medical history, severity of pain, as well as the associated risks and benefits. There exists a divergence in preferences across individuals, with certain individuals favoring Acupuncture as a therapeutic modality while others prefer conventional treatment. Integrating these methodologies can potentially enhance pain management and overall well-being (George et al., 2021). Patients must engage in discussions with healthcare professionals to ascertain the most optimal treatment strategy for their specific circumstances.
Using a 65-year-old man with chronic back pain as a case study, this essay focuses on his social dynamics, objective data, and subjective data. A treatment option that best fits the patient in the case study will be chosen, considering even social and cultural factors, after comparing and contrasting two articles on treating chronic back pain (one on pharmacotherapeutics and the other on Acupuncture).
Setting and Social Dynamics
The patient sought medical attention at a community setting facility. He is Asian, and his ethnicity is Korean-American. His cultural aspects are rooted in Korean traditions like celebrations and cuisine. He participates in traditional ceremonies like Chuseok and Seollal, reflecting his Korean heritage. He connects with extended family and often gathers to share traditional meals. He also adheres to the religious beliefs of Buddhism. He is of good social-economic status and lives with his three children and one wife.
Subjective Information
The patient presented for the clinical visit complained of lower back pain that has been there for three years. The patient notes that the back pain was of gradual onset triggered by lifting a heavy load three years ago. The pain in the lower back occasionally radiates to the lower limbs. The pain is dull, and he gives a pain score of five on a scale of one to ten. The patient has been on methocarbamol 750 mg twice daily and meloxicam 15 mg once daily since the diagnosis was made three years ago. He notes to be compliant with the medications. He notes that the above medications do not manage the pain. The pain worsens whenever he bends or engages in long periods of standing. He notes using warm compresses to alleviate the pain, which does not work either. He denies any change in bladder or bowel habits. He notes occasional tingling sensations and numbness in the lower limbs.
The patient has a past medical history of injuries where he developed a muscle sprain in the back secondary to lifting heavy loads. The patient was exposed to radiation for a lumbosacral X-ray three years ago. The patient is currently on meloxicam 15 mg once daily orally and methocarbamol 750mg twice daily orally. He has no known allergies that are either food, environment, or drug. He has a previous history of hospital admission at the same facility, whereby he was admitted three years ago after a muscle sprain. He has never undergone any surgical procedure or blood transfusion.
For his personal-social history, he does not consume alcohol, and he does not smoke marijuana or tobacco. He subscribes to the Buddhist faith and notes consuming a healthy diet. His wife is 60 years of age and has a history of hypertension. He is faithful to his wife and has no history of sexually transmitted diseases. The children are alive and well, with no history of chronic disease. He notes being stressed because of his illness which makes his sleeping difficult. The patient does not engage in physical activity because of back pain. The patient also notes to be consuming a healthy diet.
From the family history, he is the lastborn in a family of three. The firstborn, a female, is alive at 70 years with no history of chronic illness. The second born, a male, is alive with a history of chronic obstructive pulmonary disease. Both parents succumbed to a road accident 30 years ago, the mother was at 53 years, and the father was at 58 years. There is no family history of chronic disease. The paternal grandfather succumbed at 76 due to prostate cancer, while the paternal grandmother succumbed at 80 due to type 2 diabetes. The maternal grandmother succumbed at 70 due to meningitis, while the maternal grandfather succumbed at 78 due to liver cirrhosis. He is current on all his immunizations.
For the review of systems, in the genitourinary system, there is no urethral discharge, no painful or burning sensation on urination, and no blood in the urine. The respiratory system has no cough, chest pain, runny nose, or chest congestion. For the gastrointestinal system, there is no abdominal discomfort, nausea, abdominal pains, constipation, or diarrhea. The cardiovascular system has no palpitations, syncope, lower limb swelling, chest tightness, or easy fatigability. In the nervous system, there is no drowsiness, no headache, and no loss of consciousness. For the musculoskeletal system, he has back pains but no joint stiffness. For the constitutional symptoms, there is loss of weight, chills, or fever.
Objective Information
The vital signs of the patient were all within the normal range. The heart rate was 80 beats per minute, blood pressure was 102/69mmHg, pain score was five over ten, Spo2 was 97%, and body mass index was 21.76 kg/m2. On physical examination, tenderness was elicited at the lower back upon palpation; the sensation was intact, and there were no deformities in the spine, but there was reduced bending backward and forward in the back. There was a positive straight leg raise test whereby he felt pain radiating down the legs upon raising a straightened leg. His known diagnostics are the findings of a lumbosacral X-ray that revealed misalignment of two vertebras, osteophytes, and disc narrowing.
Medical Decision-Making and Clinical Impression
Based on the patient’s medical history, subjective complaints, and objective physical examination, D.N. presents with chronic low back pain (CLBP) accompanied by radiating symptoms. D.N., a 65-year-old Asian male, experienced persistent lower back pain over three years. Three years prior, raising a substantial amount of weight resulted in a persistent, dull aching that radiated through the lower limbs. The physical examination findings included pain in the lower back region, restricted mobility during bending movements, and a positive outcome on the straight leg raise test. Lumbar X-rays revealed the presence of osteophytes, vertebral misalignment, and disc constriction. These results indicate the presence of persistent chronic low back pain associated with spinal structures (George et al., 2021).
Introduction of the Two Articles
Two evidence-based therapeutic options for acute low back pain stand out. The first study, published in 2021 as “Efficacy and Safety of Acupuncture in Treating Acute Low Back Pain: A Systematic Review and Bayesian Network Meta-Analysis,” by Wu et al., investigates the treatment’s potential of Acupuncture in patients with low back pain. The other article by Schreijenberg et al.’s 2019, “Guideline Recommendations on the Pharmacological Management of Non-Specific Low Back Pain in Primary Care-Is There a Need to Change?” examines pharmacological management guidelines for chronic low back pain. Both publications address chronic back pain, a widespread medical issue affecting a huge portion of the population in different ways.
Comparison and Contrast the Two Treatment Options
The two articles provide distinct but complementary therapies for acute low back pain. Wu et al. investigate the potential of Acupuncture. Acupuncture balances “qi” by placing tiny needles into specific body areas. This traditional technique treats both physical and mental suffering. On the other hand, the article by Schreijenberg et al. treats non-specific low back pain pharmacologically. This approach uses NSAIDs, muscle relaxants, and analgesics to reduce pain and inflammation. In modern medicine, the pharmacological approach is guided by clinical trials and empirical evidence. Both Acupuncture and pharmacological therapy relieve acute low back pain, but their mechanisms differ. Acupuncture emphasizes energy flow and balance, whereas pharmaceutical therapies target pain pathways and inflammation. Acupuncture may appeal to those seeking a complete approach to pain management, including psychological and emotional components. These approaches each have their own set of dangers and benefits. Side effects from trained acupuncturists are uncommon. Side effects, medication interactions, and long-term repercussions may occur with pharmacological therapy. Medication can rapidly and precisely relieve pain.
Analysis of the Merit and Soundness of Research
Wu et al. conducted a meta-analysis of research using Bayesian networks. This technique reinforces findings by directly and indirectly comparing interventions. Systematic reviews can provide a controlled and extensive literature analysis, increasing the trustworthiness of conclusions. Because of blindness and pain perception, mainstream medicine questions the efficacy of Acupuncture. On the other hand, the publication by Schreijenberg et al. examines clinical trials and research studies to provide pharmaceutical management suggestions. Despite its long medical history and scientific support, pharmacological treatment raises concerns regarding adverse effects and overuse. Wu et al.’s study has a broader perspective, and its methodology and analysis have more research backing. It is crucial to remember, though, that selecting a course of therapy should also consider patient preferences, potential dangers, and specific circumstances.
Treatment Option Chosen for the Patient Scenario and Provided Justification
The most appropriate treatment was D.N. would be pharmacotherapeutics plus Acupuncture. Acupuncture and pharmacotherapeutics were selected based on D.N.’s demographic characteristics, medical history, and personal preferences. Other factors contributing to this decision include D.N.’s adherence to traditional Korean customs and practices, the religion commonly observed in Korea. Acupuncture, originating from Traditional Chinese Medicine, incorporates several factors such as physical, emotional, and environmental considerations while also aligning with the individual’s cultural context. The lack of therapeutic response observed in D.N. despite adherence to methocarbamol and meloxicam indicates a resistance to the prescribed medication (Tagliaferri et al., 2020). D.N. seeks a durable approach to pain management and is drawn to the potential of Acupuncture to stimulate the release of endorphins and neurotransmitters while minimizing adverse effects.
Plans, Recommendations, Education, Health Promotion, and Follow-Up
Chronic lower back pain and accompanying symptoms are treated with Acupuncture. The practice of Acupuncture will mark the initiation of this strategy. In multiple sessions, fine needles will target the body of D.N. The restoration of energy balance may achieve the alleviation of his suffering. A proficient acupuncturist will effectively manage the cultural and religious sensitivities of D.N. The medication of D.N. will undergo a concurrent review. Given the individual’s limited progress, it is deemed necessary to seek the expertise of a pain management specialist. The specialist will administer various pharmaceutical interventions or combinations thereof to address the patient’s chronic conditions (Tagliaferri et al., 2020). This approach is also dependent on education. D.N. and their spouse will learn about the etiology and treatment of chronic lumbar pain. D.N. will also acquire skills related to self-care at home. Implementing correct body mechanics, gentle stretching exercises, and the application of warm compresses can be beneficial in managing the condition (George et al., 2021). The patient will be scheduled for a follow-up every two months to assess the effectiveness of treatment.
Cultural and Socioeconomic Considerations
Understanding cultural and socioeconomic challenges in healthcare is critical to giving equal care. These considerations are critical for D.N., a Korean with strong cultural and religious beliefs. D.N.’s care is founded on cultural competency. Traditional Korean rites and diets must be followed during his therapy. Healthcare providers that understand Korean culture can assist D.N. in communicating with and trusting his doctors. Religious sensibility is also essential because his Buddhist views influence his decisions. Interventions and therapy should be consistent with his religion for comfort and compliance (George et al., 2021). If he chooses spiritual assistance, he may get the emotional and mental strength to handle his healthcare. D.N. places high importance on straightforward communication. D.N. and his wife should be able to comprehend facts. Despite language barriers, skilled interpreters can assist patients in understanding and acting on crucial medical information. Socioeconomic issues are also important in his care. D.N.’s budget and insurance coverage should drive treatment decisions. D.N. should benefit financially from affordable interventions that keep his care accessible and sustainable (Tagliaferri et al., 2020). The only way to smoothly integrate cultural and socioeconomic aspects into D.N.’s healthcare journey is to recognize and include him in decision-making. When providing fair and inclusive care, D.N.’s Korean heritage, Buddhist faith, linguistic needs, financial status, and personal preferences must all be recognized. Carefully examining these elements allows healthcare practitioners to provide D.N. with medically effective, culturally sensitive, courteous, and identity-appropriate care.
Conclusion
In conclusion, D.N., a 65-year-old Asian male with persistent low back pain, highlights the complexities of treating it. Acupuncture and pharmacotherapeutics are best for D.N.’s cultural, religious, and personal preferences. This choice acknowledges D.N.’s socioeconomic situation while blending traditional traditions with contemporary medicine. Healthcare practitioners can help D.N. manage his pain in a way that fits his values and improves his health by recognizing and respecting his cultural and personal characteristics.
References
George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., … & Vining, R. (2021). Interventions for the management of acute and chronic low back pain: revision 2021: clinical practice guidelines linked to the international classification of functioning, disability, and health from the Academy of orthopedic physical therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1-CPG60. https://www.jospt.org/doi/abs/10.2519/jospt.2021.0304
Schreijenberg, M., Koes, B. W., & Lin, C. W. C. (2019). Guideline recommendations on the pharmacological management of non-specific low back pain in primary care–is there a need to change? Expert review of clinical pharmacology, 12(2), 145-157. https://www.tandfonline.com/doi/abs/10.1080/17512433.2019.1565992
Tagliaferri, S. D., Miller, C. T., Owen, P. J., Mitchell, U. H., Brisby, H., Fitzgibbon, B., … & Belavy, D. L. (2020). Domains of chronic low back pain and assessing treatment effectiveness: a clinical perspective. Pain Practice, 20(2), 211-225. https://onlinelibrary.wiley.com/doi/abs/10.1111/papr.12846
Wu, B., Yang, L., Fu, C., Jian, G., Zhuo, Y., Yao, M., & Xiong, H. (2021). Efficacy and safety of Acupuncture in treating acute low back pain: a systematic review and Bayesian network meta-analysis. Ann Palliat Med, 10(6), 6156-6167. https://cdn.amegroups.cn/journals/amepc/files/journals/8/articles/70419/public/70419-PB3-6578-R2.pdf
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