Collaborative care for a patient with complex low back pain and long-term tobacco use: a case report

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J Can Chiropr Assoc. 2015 Sep; 59(3): 216–225.

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Table 2.

Interprofessional communications during case co-management

Week	Communication Type	Patient Goals	Interprofessional Communication Summary
1	Treatment summary/DC	Pain reduction for LBP Improved psychological management of chronic pain Improved ability to perform ADLs (gardening, walking)	Low back pain diagnosis with description and rationale for recommended treatment Lumbar distraction Gentle high velocity manipulation at the left sacroiliac joint to improve joint function Home exercise recommendations included trunk motions and brisk walking using a short stride with mild effort to tolerance Tobacco cessation advised
3	Treatment summary/DO	Short-term pain management Tobacco use cessation due to the costs of smoking and expressed embarrassment from habit	Low back pain and tobacco use diagnosis with treatment recommendations Acetaminophen recommended for short term pain relief Continue chiropractic care as scheduled Weight reduction through diet (increased physical activity not recommended due to pain with movement) Tobacco cessation with nicotine patch Review of previous medications and side effects for smoking reduction
4	Phone call summary/DO Phone call summary/DC		Tobacco use and excess weight as factors that worsen inflammation in patients with chronic low back pain Pain reduction techniques, such as relaxation response
5	Health records/DC	Tobacco use reduction or cessation	Personal Quit Plan with behavioral measures along with nicotine patch to support tobacco reduction
6	Treatment summary/DC	Tobacco use reduction or cessation	Cessation length compared to previous history (current effort lasted 6.5 days; Previous cessation lasted 6 days during an inpatient hospitalization without access to cigarettes.) Challenges related to life stresses (family stress, lack of sleep, and increased LBP combined to decrease ability to resist smoking) Home exercise recommendations included thoracolumbar lateral flexion isometric exercises
12	Phone call summary/DO Phone call summary/DC		Summary of gains with treatment Decreased pain level Improved ability to perform ADLs Reduced pain medication Future recommendations Acetaminophen as needed for pain Walking regularly for exercise Avoiding twisting and lifting while performing ADLs such as gardening Continued smoking cessation efforts.
14	Treatment summary/DC	Better understanding condition and self-management tools.	Diagnosis Summary of care Treatmentgoals Outcomes relating to decreased pain with ADLs Result of tobacco cessation effort, and Continued recommendations for tobacco reduction Performing exercises more regularly Chiropractic and/or medical care on an as needed basis