ASSESSMENT: PHARMACOTHERAPEUTIC MANAGEMENT OF COMPLEX PATIENTS PRESENTATION

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topic: EVALUATING LEGAL AND ETHICAL PRESCRIBING PRACTICES FOR PAIN MANAGEMENT

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Evaluating Legal and Ethical Prescribing Practices for Pain Management

Advanced Pharmacoulogy

July 9, 2026

Communication of Pain Management Options

I would start with identifying Craig's pain problem and make him know that having low back pain continuously is a condition that needs proper treatment. I would address him respectfully and clearly. I would inform him that there exists an option to lower his pain without making him a victim of opioid addiction. The conversation will revolve around making decisions collaboratively. Craig will be advised to discuss pain, clinical goals, occupational requirements, and the addiction component.

I would explain that nonpharmacologic therapies should be the foundation of treatment. These approaches are physical therapy, exercises, weight loss, stretching, and workplace modifications. I would also mention medications for pain not related to opioids like acetaminophen and nonsteroidal anti-inflammatory medications (NSAIDs) unless contraindicated for any reason. Duloxetine may also be considered if pain is not controlled as it has evidence in chronic musculoskeletal pain. I will explain the dangers of taking hydrocodone sourced from one’s friend. Hydrocodone is not legal, does not allow for proper monitoring, and is a risk factor for abuse and overdose (Phillips et al., 2020).

Requirements for Documentation, Monitoring, and Follow-up

Pain history of Craig, physical examination, function limitations, previous therapies, and response to treatment should be documented in his medical records. His family history of opioid abuse should also be recorded as he will be more likely to abuse them. Goals of treatment should be to improve function, not to remove all pain.

When opioid therapy is being contemplated, informed consent should be completed. Benefits, risks and alternatives should be recorded. Information from the Prescription Drug Monitoring Program (PDMP) should be checked before prescribing and during treatment. A baseline assessment for substance use risk should also be performed.

Follow-up should take place 1-4 weeks after initiation or switching of opioid therapy. At each visit, the pain relief, improved function, side effects and risk of misuse should be evaluated. Testing may be necessary once prior to beginning long-term opioid therapy, and periodically during. If the benefits are not greater than the risk, then the treatment should not be continued.

Pain Management and Prevention of Opioid Addiction

Craig suffers from chronic pain, works in a construction field, took someone else's opioid drug, and has a family history of addiction. Before beginning an opioid treatment program these factors must be taken into account. Multimodal treatment for pain should be emphasized. Exercise, education, CB techniques, and non-opioid drugs must be prioritized in the treatment. If there is no alternative to opioids, then it is advisable to prescribe the minimum required dose for the shortest possible period of time. Extended-release opioids should be avoided for patients naïve to opioids (U.S Food and Drug Administartion, 2025). Education should be provided for Craig on how to properly store, use and dispose of medications, and use drugs without alcohol or sedatives. Frequent evaluation can identify problems early on and make adjustments in treatment before addiction sets in.

Narcotic Pain Medication Options

Illinois grants full Scope of Practice for LPs and proper federal DEA registration to fully licensed NP practitioners to prescribe Schedule II–V controlled substances (IDFPR, 2024). Firstly, I would suggest alternatives to opioids for Craig due to the history of the family concerning the consumption of opioids as well as a dislike for long-term treatment with opioids. In case when this fails and Craig still experiences pain which limits his ability to function, I would prescribe a short-term therapy with immediate release hydrocodone-acetaminophen.

Ethical Considerations

Balance should be maintained between beneficence, nonmaleficence, autonomy, and justice when medications are prescribed ethically. Medications like opioids, can enable Craig to deal with his pain and go back to work. However, improperly ordered drugs can cause him addiction, overdose, or diversion. His family history and previous misuse increase these concerns. Not prescribing opioid would also be an unethical decision since Craig may end up with an out-of-control pain if not treated by an opioid. Shared decision-making with evidence-based care is the best ethical response. The approach upholds Craig's preferences, while keeping him safe, healthy, and protecting his public safety needs.

References

IDFPR. (2024). Controlled Substances. Idfpr.Illinois.Gov. https://idfpr.illinois.gov/profs/contsub.html

Phillips, J. K., Ford, M. A., & Bonnie, R. J. (2020, July 13). Evidence on Strategies for Addressing the Opioid Epidemic. Nih.Gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK458653/

U.S Food and Drug Administartion. (2025). FDA Requires Major Changes to Opioid Pain Medication Labeling to Emphasize Risks. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-requires-major-changes-opioid-pain-medication-labeling-emphasize-risks