Question

Mr. DB is a 65-year-old retired construction worker who presents with complaints of chronic bilateral shoulder pain that has worsened over the past few years and now decreased his ability to do light housework and yardwork. For his past medical history, DB has hypertension that is well controlled with hydrochlorothiazide. He is also on dispersible Aspirin 75mg daily. He has no surgical history and denies any psychiatric history. He is a denies any history of illicit drug use and addiction. He drinks 4 units of alcohol daily. He took paracetamol but had no relief. He was referred to an orthopedic surgeon in the past and had a steroid injection that only provided 3 weeks of relief. Imaging shows moderate to severe glenohumeral joint arthritis with no evidence of fracture or dislocation. An opiate risk assessment test was done to ascertain if opioids were appropriate for the management of Mr. DB’s condition.

Attempt the following questions

1. What factors would you consider when recommending an appropriate analgesic (a) non opioid analgesics (b) opioid analgesics for the management of DB’s pain

2. Why did the paracetamol not work for the management of DB’s pain?

3. What is opioid risk assessment test.

4. What should be Mr DB’s risk assessment score and what does it mean?

5. What are the goals of therapy for the management of Mr. DB’s pain?

6. What therapies would be appropriate for the management of Mr. DB’s pain.

Answer 1

1) Factors considering the recommendation of analgesics of Mr DB's pain.

Gender,age, weight, height,body surface area, smoking, alcohol use are the general factors affecting analgesic use.

In this scenario,

a) nonopioid analgesics:- arthritis, chronic pain( patient has pain for the past few years.

b) Opioid analgesics:- age - Patient is 65 year old.

Alcohol usage - patient uses 4 units of alcohol per day.

Took paracetamol and no relief.-: when non opioids are not working.

2)