A 27-Year-Old Man Comes to the Office for Follow-Up Regarding

A 27-year-old man comes to the office for follow-up regarding a herniated disc.  He first injured the disc 3 months ago while at work.  Nonsurgical treatment options, including physical therapy and as-needed NSAIDs and tramadol, were recommended.  The patient has completed physical therapy, and follow-up MRI indicates that the herniated disc has regressed.  He reports a significant amount of ongoing pain and asks for a dose increase and refill of his pain medication.  In the past month, the patient has been to the emergency department on 2 occasions to request pain medication due to running out before his next scheduled refill.  Vital signs are within normal limits, and physical examination is unremarkable.  Which of the following statements by the physician would be most appropriate at this time?

A) "Given your recent refill requests and interest in increasing your dose, I am concerned that you may be dependent on pain medication."
B) "It doesn't seem like medication is effective anymore; let's talk about alternate ways to treat your pain."
C) "Sometimes patients take pain medications to help with other types of symptoms; how has your mood been recently?"
D) "You're still experiencing a lot of pain, and it has not been easy managing it; let's discuss how you have been taking the medication."
E) "Your pain symptoms do not seem to be improving with additional medication, so a dose increase is unlikely to help you."

Correct Answer:

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