A caucasian man with hip pain

Caucasian Man with Hip Pain

Background.

A white Caucasian male aged 43 walks into the hospital assisted by crutches complaining of severe hip pain. During the first interview, he claims to have sought psychiatric help after his family doctor’s advice that his problem could be coming from his head. Although the man also had an injury at his workplace, his doctor says that he is making things up as he uses narcotics.

An inch of X-rays, CT scans, and MRIs were performed on him to treat this, but none of the doctors gave the green light for a hip replacement cleaning; he was too young for it. One neurologist claimed the man has the sympathetic reflex syndrome, but his family doctor disagreed, advising him to seek psychiatric help. With that, I made the following decisions.

Reflex Sympathetic Dystrophy

The patient has had reflex sympathetic dystrophy for seven years. Treatment for this condition has to be individualized. According to Potalivo & Bugliantella (2017), the main reason for this kind of treatment is to reduce pain and restore the affected area’s proper functioning.

Decision 1

Amitriptyline 25 mg PO

During the evaluation, the patient indicates a history of reflex sympathetic dystrophy (RSD). He denies that he’s depressed but explained that he lost his well-paying job and his fiancé. Moreover, his right leg was visibly cramped and discolored. In the initial choice, Savella, Amitriptyline, and Neurontin were available for picking. The patient’s best medication option was 25Mg of Amitriptyline PO QHS under a weekly titration by 25mg to an optimal dosage of 200Mg daily. The medication was appropriate as it alleviates nerve pain and depression. Though the patient denies it, one may conclude that he is either depressed or will be depressed.

Rationale

The treatment goal is to alleviate pain, prevent the patient from gaining weight, and improve sleeping patterns for four weeks consecutively. Harder et al. (2003) indicate that Amitriptyline is the best medication to achieve some treatment goals as it alleviates pain by at least 50%. However, the drawback for the drug is that it may cause an increase in weight as it boosts the patient’s appetite and cravings for carbohydrates (McCloughan & Foster, 2011)

Anticipated results of the decision

The patient is expected to report lower pain levels of less than 7 out of 10 on the pain scale. The patient is expected to report better sleeping patterns and no changes the weight. According to Mackey & Feinberg (2007), the sedation properties in Amitriptyline stimulates sleep. However, the medication reduces pain levels in four or more weeks.

Expected Outcomes Versus Actual Outcomes

The pain scale indicates a pain level of 6 out of 10. There was an improvement in the patient’s mobility, and he reported reduced grogginess initially resulting from poor sleep patterns. He also reported no weight gain due to the low doses of Amitriptyline. However, the patient reported increased tiredness, which was not an expected outcome; This may attribute to taking the medication immediately before bedtime.

Decision 2

Add Amitriptyline dosage to 125Mg during sleeping time.

The second choice was to maintain the current medication but up the dose to 125 mg at bedtime. The patient was required to take the medication in one hour before going to sleep to protect him from feeling dazed in the morning. Amitriptyline’s maintained dosage is around 100 mg but can be increased if need be, but it may increase its side effects (Drugs. Com, 2018).

Rationale

Since the patient did not report any contraindications, it was okay to increase the dosage. It was also essential to change administration time to reduce grogginess in the morning due to the drug’s sedation properties (Harden et al., 2013).

Anticipated results of the decision

It is expected that the pain levels would reduce to 5 out of 10; the patient would experience an insignificant weight gain and would stop feeling dazed upon waking up. With an increase in dosage, carbohydrate craving increased; thus, the patient would gain some weight (Drugs. Com, 2018). Moreover, the pain was expected to reduce significantly, as the drug’s effects were to be felt during these four to six-week periods (Harden et al., 2013).

Expected Outcomes Versus Actual Outcomes

The patient’s response to the drug was not as expected but had no adverse effects. He reported reduced pain and grogginess and a five-pound weight gain.

Decision 3

Administer the current dose of 125Mg Amitriptyline consistently and refer the patient to a dietician for nutritional advice.

The final decision was for the patient to continue with the 125 mg Amitriptyline and visit a life coach. The medication would completely eradicate the pain while the coach was to monitor his diet, meaning there’s a response to treatment (Mackey & Feinberg, 2007). Weight gain at this point should be minimal but can be controlled by lifestyle change. Moreover, the patient should see an occupational therapist and physical therapist help reduce pain and improve functional capacity in the client (Harden et al., 2013). Furthermore, occupational and physical therapy can help reduce the weight gained by increasing the patient’s physical activities (McCloughen & Foster, 2011).

Ethical consideration

Ethical consideration is a modification to medication. If the current prescription does not improve the patient’s health, it is logical to change it. It is also essential to thoroughly evaluate the patient and let him know his exact health (Mardones & Larrain, 2015). In this case, the man was told to expect some pain level as he has reflex sympathetic dystrophy.

Patient education is another important ethical consideration. The patient is informed of what will happen during and after medication. Its side effects and how to deal with them. The nurse also dictates the importance of sticking to the prescription.

Reference

Amitriptyline – FDA prescribing information, side effects, and uses. (2018, April 5). Retrieved from https://www.drugs.com/pro/amitriptyline.html

Complex Regional Pain Syndrome National Institute of Neurological Disorders and Stroke. (2017, November 14). Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet#How%20is%20CRPS%20treated?

Haanpää, M. L., Gourlay, G. K., Kent, J. L., Miaskowski, C., Raja, S. N., Schmader, K. E., & Wells, C. D. (2010). Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities. Mayo Clinic Proceedings, 85(3), S15-S25. DOI:10.4065/mcp.2009.0645

Harden, R. N., Oaklander, A. L., Burton, A. W., Perez, R. S., Richardson, K., Swan, M., … Bruehl, S. (2013). Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 4th Edition. Pain Medicine, 14(2), 180-229. DOI:10.1111/pme.12033

Mackey, S., & Feinberg, S. (2007). Pharmacologic therapies for complex regional pain syndrome. Current Pain and Headache Reports, 11(1), 38-43. DOI: 10.1007/s11916-007-0020-z/

McCloughen, A., & Foster, K. (2011). Weight gain associated with taking psychotropic medication: An integrative review. International Journal of Mental Health Nursing, 20(3), 202-222. DOI:10.1111/j.1447-0349.2010.00721.x/

Potalivo, G., & Bugiantella, W. (2017). Snapping Hip Syndrome: Systematic Review of Surgical Treatment. Hip International, 0-0. http://dx.doi.org/10.5301/hipint.5000464/