Scenario 1: A patient with chronic back pain requests a narcotic prescription. Hypothesis: In patients with chronic back pain not caused by injury, what is the effect of eight weeks of physical therapy compared to oral narcotic medication on the patients’ perception of pain? Hypothesis: Are patients with chronic back pain who are denied narcotic pain medications at increased risk of depression as compared to patients on a prescribed pain regimen using oral narcotics?

Scenario 1: A patient with chronic back pain requests a narcotic prescription. Hypothesis: In patients with chronic back pain not caused by injury, what is the effect of eight weeks of physical therapy compared to oral narcotic medication on the patients’ perception of pain? Hypothesis: Are patients with chronic back pain who are denied narcotic pain medications at increased risk of depression as compared to patients on a prescribed pain regimen using oral narcotics?

I agree with you that a thorough evaluation of a patient who reports chronic pain is essential to determine if the patient’s pain is caused by Physiological processes or mental processes. On the other hand, the consideration of patient autonomy is a vital factor for making a decision on whether to administer oral narcotic medication or physical therapy to a patient. According to Lajam et al. (2019), a patient can therefore only exercise effective autonomy if they are well informed and educated on a given subject. Effective patient education on various issues related to physical therapy or administration of oral narcotics would therefore be needed before administering any of the interventions to relieve pain in the patient who reports chronic back pain. For instance, the patient would need to be educated that physical therapy will not be an instant relief for their chronic back pain but might be the more sustainable approach to relieve pain due to the absence of any severe side effects. On the other hand, the patient would need to be educated that oral narcotic prescriptions can bring the fastest relief of pain but may increase the chances of severe side effects, including addiction. A consideration of the past history of the patient, including any reported abuse of pain medication such as opioids, can also be a significant factor in determining whether to administer oral narcotic medication to the patient or recommend physical therapy. It will therefore be unethical and unprofessional for a healthcare practitioner to recommend narcotic medication that might be addictive to a patient with a history of opioid pain medication addiction (Lajam et al., 2019

References

Lajam, C. M., Cenname, J., Hutzler, L. H., & Bosco, J. A. (2019). Ethics of Opioid Prescriber Regulations. Journal of Bone and Joint Surgery, 101(23), e128. https://doi.org/10.2106/jbjs.19.00437