Case Study 1

Rebecca, a 54-year-old woman, was discharged from the emergency department (ED) 3 days ago and is being seen in your office for a follow-up visit. Rebecca is 12 weeks post-hysterectomy and transported herself to the ED with complaints of abdominal pain and chills. Test results from the ED were negative for infection or postsurgical complications. Rebecca was given morphine in the hospital to manage her postsurgical pain and was given a 30-day prescription of Percocet at discharge. When this prescription is exhausted, she now attempts to manage the pain with over-the-counter painkillers (e.g., Tylenol, Advil), but they have been ineffective in managing her pain. The ED health-care provider refused to write another pain management prescription until she could be seen by her primary-care provider. Rebecca noted on todays intake form that she has trouble sleeping and flu-like symptoms (e.g., muscle pain, bone pain, and chills).

Case Questions

1.Assuming that tests performed in the ED ruled out any postsurgical complications or infection, what can be used to help manage pain?
2.Given the symptoms reported by Rebecca and the amount of time since her surgery, you suspect that Rebecca may be exhibiting signs of opioid withdrawal. What are the signs of opioid dependence and withdrawal?
3.Rebeccas intake form reveals a number of the symptoms associated with opioid withdrawal. Do these symptoms indicate opioid abuse or dependence?
4.What has caused the current epidemic of opioid abuse, and what are the most popular drugs of abuse?
5.Why does the pain relief provided by opioids increase the risk of addiction, and what is your responsibility, as the health-care provider, when prescribing opioids?