Pain is an undesirable experience that affects the internal and external status of the patient in question. It can be managed by different techniques depending on its intensity and effect on the patient. Only the patient can rate the scale of the pain as he/she is directly experiencing it. The approach and understanding of the causes of pain directly impact the relationship between the patient and the physician. The fact that pain is subjective makes it challenging to be managed ( Thorn, 2017). Given this, the paper addresses the different decisions arrived at in the pain management and treatment of a 43-year old white male in the case study.
After a complex physical and mental analysis, the patient is diagnosed with Complex regional pain disorder (reflex sympathetic dystrophy). Different decisions are made by physicians to meet the short and long-term goals and objectives with regards to the management of the diagnosis. Therefore, the steps to be followed are addressed in different decisions.
Delegate your assignment to our experts and they will do the rest.
Decision Point One
First, the patient should be administered with Amitriptyline 25 mg po QHS. It should then be titrated 25mg weekly until it reaches the maximum dosage of 200 mg. The dosage should be per 25mg of dayriptyline po QHS. The 25mg of dayriptyline po QHS should also be titrated weekly in the intervals of 25 mg until it reaches a maximum of 200 mg in a day. The choice of this decision is based on its effectiveness on the treatment of Neuropathic pain ( David & Pardo, 2018). Also, its gradual increment offers room for the patient’s system to adjust and manage the underlying pain. Through this decision, the patient’s pain would gradually decrease until it could be insignificant. Initially, the patients rating of the pain was at nine on the scale of 1 to 10. With the gradual increase in the dosage, it would be expected that the intensity of the pain would be decreased eventually.
Notably, this decision expected that the pain would reduce to 5. However, according to the patient, the pain reduced to 7, and this was a significant improvement, but it was different from expectations. The difference is due to the incomplete dosage. Since the administration of the drug was on an incremental basis, the condition was bound to be eventually managed based on the positive effect that had been reported.
Decision Point Two
After the first visit, the patient should be advised to continue with the same prescription but increase the dosage to 125 mg. The dosage should be taken an hour earlier than the previous one and during bedtime. Furthermore, there should be a close follow-up on the progress of the patient with regards to his progress. He should be instructed to call after three days to report his progress on pain management.
The decision point is crucial as it keeps in track the effects of the medications on the patient. It minimizes the chances of subjecting the patient to long-term pain due to the side effects as the patient welfare is taken into consideration. At this point, if the side effects proved to be adverse and unmanageable, the patient’s medication can be altered (Kinney, 2019). Also, the adjustments of the dosages and timing impacted positively on the pain management issues towards the goals of the patient.
Based on his report, his mornings were no longer cloggy. Therefore, the adjustment of the timing of the medications was appropriate (Thorn, 2017). Also, the extent of the pain had improved as he reported a level of 4 on a scale of one to ten. At the moment, the patient can easily move around without the crutches, and this is a significant improvement on the path of the patient. Even though the pain has not been completely eradicated, the patient is in the right direction.
Decision Point Three
At this point, the patient should maintain the rate of dosage (125 mg) and shift to Elavil. Also, the patient should be administered with Qsymia (phentermine and topiramate) 3.75 mg/23 mg per day. It should be taken once a day and titrated based on the patient’s needs.
The decision is based on the effects of drugs that had been taken earlier. Amitriptyline which is the primary medication for the patient is characterised with considerable weight gain in both the short and the long-term basis. Thus, its minimization and immediate halt can be the solution to the impending weight gain. However, this is contrary to the goals of the patient, as his pain will return immediately. In the quest to counter this situation, Osymia should be administered. It should be administered explicitly to individuals that exhibit elements of obesity and not otherwise. The benchmark for this drug is a BMI of 30 and above. The patient in question has a BMI of 25.5, and as such, he does not need this medication. Markedly, to handle his weight gain issues, he should be subjected to counselling and dietary advice. Here, his lifestyle will be based on the types of food and exercises he will be subjected to. Thus, the only medication, in this case, will be Elavil. In the end, it is expected that the patient will handle both his pain and weight because the level of pain arrived at through the medication is manageable. The functionality of the patient should not be at stake ( Darnall et al., 2016). These results have been attained considering he does not use his clutches at all times, and he is still positive minded.
Ethical Considerations
Patient confidentiality should be embraced with regards to patient welfare. The patient in question does not think that he is depressed with his current situation, and as a result, he ignores this idea. Thus, in the quest to enhance great relationship during the treatment exercise, it is crucial to keep any information given by the patient during his treatment ( Kinney, 2019). For instance, the personal life of the patient should not be shared with other parties as this will minimize the level of trust of the patient and hence reduce the chances of managing the internal and external pain.
Conclusion
Pain management is a complex process that is marred with different decisions. The initial decisions enhance the minimization of the overall pain to arrive at the goal of the patient. The gradual increase of the dosage encourages the body to manage and enhance its pain management techniques. Once the goals are attained, the side effects of the drugs are dealt with to restore the living standards of the patient in question. To enhance the success of the decisions arrived at, it is crucial to embrace the required ethical standards. For instance, to enhance patient trust, the confidential aspect should be embraced. In the end, the issue of pain can be gradually managed to result in long-term results.
References
Darnall, B. D., Scheman, J., Davin, S., Burns, J. W., Murphy, J. L., Wilson, A. C., ... & Mackey, S. C. (2016). Pain psychology: A global needs assessment and national call to action. Pain Medicine , 17 (2), 250-263.
David, C. A., & Pardo, N. (2018). Reconsidering Psychopharmacology: The Logical Approach. J Tradit Med Clin Natur , 7 (266), 2.
Kinney, J. S. (2018). Recreation Therapists' Knowledge and Attitudes toward Pain. Therapeutic Recreation Journal , 52 (4), 309-328.
Kinney, J. S. (2019). Pain Management in Recreation Therapy Practice. Therapeutic Recreation Journal , 53 (1).
Thorn, B. E. (2017). Cognitive therapy for chronic pain: a step-by-step guide . Guilford Publications.
