1. The patient is a 58-year-old woman with chronic pain due to inflammatory arthritis. She
presents for her first appointment with you in a primary care
... [Show More] office. She states that she is
aware that she is asking for an early refill of her Oxycontin however she is traveling out
of state and she is concerned that she may have a flare up on her trip.
a. Inflammatory arthritis is a chronic pain disease that affects people of any ages
(Guo et al., 2018). Long-term opioid use is the most often treatment for
inflammatory arthritis (Guo et al., 2018). Arthritis is one of the main causes of
primary care visits, as well as a chronic debilitating disease (Shams et al., 2021).
These patients are at a higher use of addiction and substance abuse due to chronic
pain (Shams et al., 2021). This disease can be diagnosed at any age (Shams et al.,
2021).
b. Apply the steps in SBIRT to this scenario
i. Screening, Brief Intervention and Referral to Treatment (SBIRT) is a
complete, joined, public health method to the distribution of initial
involvement and treatment services for a person with substance use
disorders (Commonwealth of Massachusetts, 2022). The SBIRT is also for
people who are most at jeopardy of developing these disorders
(Commonwealth of Massachusetts, 2022). Early intervention for at risk
substance abuse disorders are conducted through Primary care centers,
hospital emergency rooms, trauma centers, and other community settings
(Commonwealth of Massachusetts, 2022).
ii. The first step in SBIRT is raise the subject which means build rapport, ask
for permission, discuss confidentiality agreement, and if given permission
advance to step 2 (Substance Abuse and Mental Health Services
Administration, 2017).
iii. The second step is to provide feedback which means provide the risk score
from step 1, compare the results with national standard guidelines, then
gather the patient’s reaction (Substance Abuse and Mental Health Services
Administration, 2017).
iv. The third step is to enhance motivation this is summarizing the patients
response, asking about the effects of the medication use, summarizing
what has been said, integrating faith if needed, share personal reflection
based on previous steps, the last part is the readiness scale on a scale of 0-
10 readiness to make a plan (Substance Abuse and Mental Health Services
Administration, 2017).
v. The fourth step is to negotiate a plan meaning summarizing the discussion
from previous steps, negotiating plans for change, faith integration if
needed, giving information on resources and offering advice, refer the
patient for treatment to a substance use disorder provider, and scheduling a
follow-up appointment (Substance Abuse and Mental Health Services
Administration, 2017).
c. Identify additional questions for this patient
i. What other medications have you tried previously?
ii. Have you tried NSAIDs before?
iii. How many times a day are you taking the Oxycontin?
iv. Are you taking the Oxycontin as prescribed?
v. Are you giving the Oxycontin to anyone else?
vi. Which physician wrote the prescription for Oxycontin?
vii. How long have you been taking the OxyContin?
d. Develop a treatment plan for this patient
i. Meloxicam in an NSAID to help with inflammatory arthritis,
osteoarthritis, and rheumatoid arthritis (Guo et al., 2018). A steroid is also
a medication that can be used as an anti-inflammatory medication for
arthritis (Guo et al., 2018).
ii. RX: Meloxicam 7.5 mg by mouth daily disp: 30 Refills: 1
iii. RX: Prednisone 20 mg by mouth daily as needed for flair ups disp: 20
Refills: 0
iv. Education: Take medications with food to avoid GI upset. Take all
medications as prescribed. Take the medicine as soon as you can but skip
the missed dose if it is almost time for your next dose. Do not take two
doses at one time. Avoid alcohol while taking meloxicam. Heavy drinking
can increase your risk of stomach bleeding. Avoid taking aspirin while you
are taking meloxicam, unless your doctor tells you to. Ask a doctor or
pharmacist before using other medicines for pain, fever, swelling, or
cold/flu symptoms. They may contain ingredients like meloxicam (such as
aspirin, ibuprofen, ketoprofen, or naproxen). Ask your doctor before using
meloxicam if you take an antidepressant. Taking certain antidepressants
with an NSAID may cause you to bruise or bleed easily (Guo et al., 2018).
v. Diagnostic Testing: The patient would need to have blood work completed
today because of the inflammatory arthritis; we also need to get a baseline.
We should also request records from previous provider. The inflammatory
markers would include CRP, sed rate (Guo et al., 2018). We would also
need to get an x-ray of her joints to determine if there is extensive
inflammation.
vi. There is non-pharmacological treatment that can help the patient with
decreased pain as well (Shams et al., 2021). She needs to incorporate an
arthritis diet including fruits: any fresh or unsweetened frozen fruits,
especially berries, vegetables: any (raw or cooked), beans and legumes,
whole and cracked grains, healthy fats like nuts, avocado, olive oil, whole
soy foods like tofu or tempeh, fish and seafood, spices, herbs, herbal teas,
cooked Asian mushrooms and red wine, dark chocolate (in moderation)
(Shams et al., 2021). She needs to avoid Frozen or packaged dinner meals,
packaged snack foods, desserts, sweets, baked goods, ice cream, fast food,
fried foods, soda or soft drinks sweetened with sugar or artificial
sweeteners, foods made with white flour or sugar, margarine and foods
made with omega-6 oil, red meat and dairy products (Shams et al., 2021).
Exercise such as walking, stretching, water activities (swimming), yoga,
cycling, strength training, and gardening for good for inflammatory
arthritis (Shams et al., 2021). [Show Less]