Answer

Case Study: Prescribed Drugs with Complementary and Alternative Medicines

Diagnosis

Mr. X is likely suffering from mechanical back strain(El Sayed & Callahan, 2020).

Rationale: mechanical back strain from the skiing accident 10 years ago (Alexander & Varacallo, 2020).

• The injury explains lower back pain, low back stiffness and accessional spasms (El Sayed & Callahan, 2020).
• The inciting incident was the skiing incident but has been triggered after he moved some boxes during the day of hospitalization.

Treatment Plan

Pharmacologic Intervention

• First-line pharmacologic intervention: muscle relaxants and nonsteroidal anti-inflammatory drugs (El Sayed & Callahan, 2020).
• Opioid medications should be avoided since Mr. X’s pain is mild (3-4 out of 10) rather than severe (El Sayed & Callahan, 2020).
• Second-line medications may include duloxetine and tramadol (El Sayed & Callahan, 2020).

Treatment Plan

Non-Pharmacologic Intervention

• The first-line non-pharmacologic interventions include acupuncture, spinal manipulation, superficial heat stimulation, and massage (El Sayed & Callahan, 2020).
• Other important interventions: exercise, yoga, tai-chi, and/or psychotherapy (El Sayed & Callahan, 2020).
• Multidisciplinary rehabilitation, electromyogram biofeedback, and low-level therapy are also other useful interventions in this case (El Sayed & Callahan, 2020).
• Exercise and physical therapy on a regular medically-supervised program (Pergolizzi & LeQuang, 2020).
• STarT Back Screening Test (StarT Back) to identify risk for development of more persistent symptoms such as fear-avoidance, mood disturbances, and/or high level of perceived pain (Pergolizzi & LeQuang, 2020).
• Consideration for appropriate behavioral interventions, physical therapy, and other interventions for psychological factors (Pergolizzi & LeQuang, 2020).

Over-the-Counter Medications

Interaction with Chronic or Acute Diseases

• CoEnzymeQ10 may worsen prognosis of deep venous thrombosis (Prescribers’ Digital Reference, 2020).
• Kava kava helps to relieve stress and anxiety (Carter & Kandola, 2018).
• Kava may have benefits in management of chronic and acute lower back pain (Bian et al., 2020).

Interactions with other Medications

• CoEnzymeQ10 should not be taken together with blood thinning medications (Prescribers’ Digital Reference, 2020).
• Kava kava may decrease breakdown of ibuprofen and warfarin in the liver (WebMD, 2020).
• Kava can also decrease the rate of breakdown of tramadol in the liver (WebMD, 2020).

Side Effects

• CoEnzymeQ10 may cause gastrointestinal discomfort (Prescribers’ Digital Reference, 2020).
• Kava kava is hepatotoxic and may cause liver damage (Carter & Kandola, 2018).
• Kava is associated with significant hepatotoxic risk (Bian et al., 2020).
• Kava kava may also cause other symptoms such as rash, fatigue, nausea, jaundice, abnormal enzyme levels, and fever (Carter & Kandola, 2018).
• Education Plan for Mr. X
• Exercise may improve his ability to self-manage his low back pain (El Sayed & Callahan, 2020).
• Weight loss and smoking cessation (El Sayed & Callahan, 2020).
• Maintenance of BMI <25 can contribute to achievement of better outcomes (Casiano, Dydyk & Varacallo, 2020).
• Drug side effects and potential drug-drug interactions.
• Reduction of strenuous physical movements may (El Sayed & Callahan, 2020).
• Physical exercises improved management of non-specific low back pain (Alzahrani et al., 2019).
• Stretching exercises, ergonomic modifications, and use of appropriate back rest breaks in the workplace (El Sayed & Callahan, 2020).
• Maintenance of proper posture and avoidance of lifting of heavy objects or weights (El Sayed & Callahan, 2020).