Complex Regional Pain Disorder White Male With Hip Pain Essay

Complex Regional Pain Disorder White Male With Hip Pain Essay

Complex Regional Pain Disorder White Male With Hip Pain Essay

Complex Regional Pain Disorder White Male With Hip Pain Sample Essay

Case Study Summary and Decisions Taken

The case study concerns a 43-year-old man with a primary complaint of pain and uses crutches to ambulate. He has been referred by his family physician for a psychiatric evaluation since the physician perceives that the pain is psychological. The physician also thinks that the patient is lying about his pain to get a narcotics prescription to get high. He is diagnosed with Complex regional pain disorder (reflex sympathetic dystrophy). The first decision was to initiate Savella 12.5 mg once daily on day 1; followed by 12.5 mg BID on days 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter. The second decision was to continue with the current Savella but reduce the dose to 25 mg twice a day. The third decision was to change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME.

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Whether the Decisions Provided Were Supported By the Evidence-Based Literature

The decision to start the patient on Savella is supported by evidence-based literature, which recommends it for fibromyalgia. Savella is a serotonin-norepinephrine reuptake inhibitor that has NMDA antagonist activity that produces analgesia at the nerve endings (Robinson et al., 2022). Gupta et al. (2021) explain that Savella is intended to alleviate pain levels, improve fibromyalgia, and improve physical activity. The Savella dose was lowered in the second decision to lower the severity of the drug’s adverse effects like nausea, insomnia, sweating, nervousness, and hot flashes.  Gupta et al. (2021) evaluated studies that established that the risk of adverse events with Savella is not to be significantly higher than the risks linked with other medications approved to treat fibromyalgia. In the third decision, Savella was changed to 25 mg in the morning and 50 mg at bedtime since an increased dose at bedtime promotes pain relief when the patient has less pain control O(Farag et al., 2022).

What Were You Hoping To Achieve With the Decisions

The PMHNP hoped that initiating the patient on Savella would lower the severity of hip pain. Keks et al. (2018) explain that Savella effectively improves pain, fatigue, and function in patients with fibromyalgia. In decision two, I hoped that lowering the dose of Savella would alleviate the drug’s associated side effects while providing adequate pain relief.  Robinson et al. (2022) conducted a review that found Savella to be associated with reduced pain but an increased incidence of side effects. In decision three, I hoped that reducing the morning dose and increasing the bedtime dose would improve the pain, while at the same time reducing the side effects.

Difference between What You Expected To Achieve With Each of the Decisions and the Results of the Decisions

In decision one, the expected outcomes were similar to the actual results since the patient returned to the clinic after four weeks without using clutches but with a bit of limping. He reported that the pain was more manageable. However, he reported side effects of increased sweating, sleeping difficulties, nausea, and palpitations, which were anticipated. The expected outcomes in decision two differed from the results since the patient’s pain worsened after reducing the dose. Nonetheless, the side effects of insomnia, nervousness, and palpitations had been controlled as expected.

References

Farag, H. M., Yunusa, I., Goswami, H., Sultan, I., Doucette, J. A., & Eguale, T. (2022). Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA network open, 5(5), e2212939. https://doi.org/10.1001/jamanetworkopen.2022.12939

Gupta, H., Girma, B., Jenkins, J. S., Kaufman, S. E., Lee, C. A., & Kaye, A. D. (2021). Milnacipran for the Treatment of Fibromyalgia. Health psychology research, 9(1), 25532. https://doi.org/10.52965/001c.25532

Keks, N. A., Hope, J., Keogh, S., & Copolov, D. L. (2018). Milnacipran: serotonin-noradrenaline reuptake inhibitor approved for fibromyalgia may be a useful antidepressant. Australasian psychiatry: bulletin of Royal Australian and New Zealand College of Psychiatrists, 26(5), 537–540. https://doi.org/10.1177/1039856218794874

Robinson, C., Dalal, S., Chitneni, A., Patil, A., Berger, A. A., Mahmood, S., Orhurhu, V., Kaye, A. D., & Hasoon, J. (2022). A Look at Commonly Utilized Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) in Chronic Pain. Health psychology research, 10(3), 32309. https://doi.org/10.52965/001c.32309

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For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Write a 1- to 2-page summary paper that addresses the following:

• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
• Link to ineractive lab:http://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html