Pain influences the physical wellbeing of a patient as well as their mental health. Sometimes it is difficult for healthcare providers to treat pain since there is no accurate tool to measure pain, and they rely on the scale given by the patient indicating how severe their pain is. The purpose of this paper is to outline three decisions that will be used to treat a 43-years-old white male who was diagnosed with complex regional pain disorder.
Decision 1
Savella 12.5 mg once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID for the next three weeks.
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Savella is a serotonin-norepinephrine reuptake inhibitor used in the clinical treatment of fibromyalgia. Savella is a weak noncompetitive NMDA-receptor antagonist, which may contribute to the action of chronic pain. The reason why I did not prescribe amitriptyline to the patient is that this drug is a tricyclic antidepressant (Stahl, 2008). This kind of medication can result in unwanted side effects such as sedation, blurred vision, weight gain, and dry mouth. The patient particularly did not like the drugs that were initially prescribed to him since they triggered constipation and sedation, and this should be considered when selecting the drug for the patient. Another side effect of tricyclic antidepressants is that it causes sexual dysfunction (Palmer, 2015).
On the other hand, Neurontin300 po causes sedation. At the end of fours, I expect the client to cease using clutches, and his pain will have reduced. When the client comes back to the clinic after four weeks, he showed up without clutches, but he was limping a bit and reported that his pain level was four on a scale of one to ten. The differences between the expected and actual results are that the drug had side effects on the patient, and he reported sweating, high blood pressure and nausea, and pulse slightly elevated.
Decision 2
Continue with current medication but lower dose to 25 mg twice a day
Most of the side effects linked to this drug are dose-dependent. Since all the sides that the client is experiencing are linked to Savella dose, the only way to minimize them is by lowering the dose administered to the client, although this may result in the client feeling more pain again. Savella has been an effective pain reduction drug. So hopefully, a lower dosage will help continue easing the client pain as well as lessen the side effects. After four weeks, the client reported back to the clinic for a follow-up. He comes back using clutches, and his pain had risen to a scale of 7 out of 10. The pain is waking him frequently in the middle of the night. Although this was not the expected outcome, I was aware there was a possibility the pain would increase due to a reduction of the dose.
Decision 3
Change Savella to 25 mg orally in the morning and 50 mg at bedtime
Initially, the client has been on 25mg of Savella twice a day without any side effects. The dosage has assisted the client in lowering pain, but the dosage was too high. With this treatment, I am hoping the client will experience pain relief when the dosage is increased to 50mn without any adverse effects. Starting treatment on the client using tramadol is not the best practice since it is used to cure acute pain when the injuries initially occur, but the client's condition of pain is chronic (Patetsos, & Horjales-Araujo, 2016). After one month, the client reported back to the hospital, and he was no longer using crutches. His pain had reduced significantly and had not experienced any side effects.
It is essential to review the ethical issues and considerations when recommending the patient to a drug. First, it is important to begin by evaluating the patient's historical health background to avoid the challenge of the wrong diagnosis. It is also advisable to review the treatment procedures to employ when treating the patients and allowing them to know their health status information (Mackey & Feinberg, 2007)
References
Mackey, S., & Feinberg, S. (2007). Pharmacologic Therapies for Complex Regional Pain Syndrome. Current Pain and Headache Reports , 11 (1), 38–43.
Marks, D. M., Patkar, A. A., Masand, P. S., & Pae, C.-U. (2009). Does Pregabalin Have Neuropsychotropic Effects?: A Short Perspective. Psychiatry Investigation , 6 (2), 55–58. http://doi.org/10.4306/pi.2009.6.2.55
Palmer, G. (2015). Complex regional pain syndrome. Australian Prescriber , 38 (3), 82–86. http://doi.org/10.18773/austprescr.2015.029
Patetsos, E., & Horjales-Araujo, E. (2016). Treating Chronic Pain with SSRIs: What Do We Know? Pain Research & Management , 2016 , 2020915. http://doi.org/10.1155/2016/2020915
Stahl, S. M. (2008). Essential Psychopharmacology Online. Retrieved June 26, 2018 from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?page=9781316618134c114.html.specialpopulations&name=SERTRALINE&title=Special%20Populations
