Pro Vs. Con Debate on Prescribing Pro: Maxim Eckmann, MD Con: - PowerPoint PPT Presentation

Pro Vs. Con Debate on Prescribing Pro: Maxim Eckmann, MD Con: Ameet Nagpal, MD Moderator: Miles Day, MD

Disclaimer • We will passionately debate our stances but they do not necessarily reflect our own viewpoints

Case • A 28-year-old single male presents to your clinic for a new patient evaluation. He has had low back for 5 years following a motor vehicle collision. The diagnosis was discogenic low back pain that was identified by a combination of magnetic resonance imaging and provocation discography. A microdiscectomy procedure performed one year after the collision was not effective in reducing his pain. He eventually was referred to a pain management provider who supported the ongoing use of hydrocodone/acetaminophen 10mg/325mg, 4 per day.

Case • For the past 3 years, his primary care provider has been prescribing this medication, but that provider will be retiring before the patient’s next monthly prescription is due and no one in that medical clinic is willing to take over his care. He states that the medication allows him to be more functional, which he describes as walking 2 miles on most days, with an average pain level of 3 on a 0-10 numeric rating scale. The original motor vehicle claim has since been legally settled and his income is now primarily from social security disability due to chronic low back pain, which he was awarded on an appeal. He was a laborer prior to the motor vehicle collision and he has no specific return to work goals.

Case • At the new patient evaluation, he denies other medical problems and denies taking any other prescription medication. He takes generic ibuprofen about 50% of the days, usually 600 to 800mg per day. His alcohol consumption is reported as a “six pack per week.” He responds that he once obtained “professional counseling” for his pain, but that was “not effective.” His previous provider “trusted” him enough that he did not have to sign a pain contract. He was also unaware of the process of urine testing. He is now requesting that you continue the opioid prescription or he fears that he will have to turn to illegal sources.

Question • Would you continue this patient’s opioid prescription? Why?

Question • Does the patient’s functional improvement with previous hydrocodone prescription alter your decision making?

Question • Does the patient’s alcohol use alter your decision making?

Question • Does the patient’s lack of desire to return to work alter your decision making?

Question • Does the patient’s statement that he “might have to turn to illegal sources” alter your decision making?

Question • Does the current pandemic influence your decision making?

Question • Would you consider telemedicine encounters for this patient moving forward?

Question • What would make you change your mind?

Audience Questions

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