Howard is a 24 year-old male who presents to the clinic his wife for what he states is severe lower back pain. he states the pain is so bad that he rates it as a "50 out of 10." he also tells you that due to a past medical history of an ulcer, he cannot take any medications "like motrin." he states that the pain is from a car accident in 2012, and that it flairs up and he needs pain medications. he also tells you that he has a high pain tolerance, and that when he gets pain meds he requires the higher doses?