According to Elsamadicy et al. (2018), Complex Regional Pain Syndrome (CRPS) is a complication led by injury or fracture. The first initiative based on the patient history is examining the clinical history and physical examination. In addition, I would consider assessing the steps towards pain relief. For instance, through a duplex, imaging is effective in determining the flow of blood or the presence of any obstruction in any location. The paper focuses on examining the patient case study and offering a treatment based on the neurological disorder symptoms.
I will address about a 43 years old white male with a chief complaint of pain. The patient ambulates using a set of crutches. According to the patient, the family doctor has sent him for psychiatric assessment claiming that the pain originated from the head. However, the patient says that the pain originated after a fall at his work 7 years ago. He had numerous diagnoses such as MRI, X-rays, and CT scans. The neurologist report identified the patient as suffering from a complex regional pain syndrome (CRPS).
Decision Recommended to the patient based on Case Study
According to Saleh and Librianto (2021), the use of an MRI helps determine mechanical abnormalities such as osteoarthritis, pinched nerves, and radical pain. Moreover, I would consider ruling out the psychosis, infection, and depression before prescribing medication to the patient (Rosenthal & Burchum, 2021). The first decision I would make is to prescribe amitriptyline. Amitriptyline is an antidepressant that hinders the uptake of norepinephrine and serotonin neurotransmitters (Thour & Marwaha, 2019). The drug binds to muscarinic (MI), alpha–endoergic, and histamine (HI) receptors (Thour & Marwaha, 2019). Therapeutic action for Amitriptyline onset takes approximately 2 to 4 weeks. The initial dosage is 25 mg at bedtime.
However, a patient should continue using amitriptyline for longer than three months, which is an effective way to overcome depression. The half-life for amitriptyline is 10 to 28 hours (Thour & Marwaha, 2019). The administration routine is through the intramuscular route, and the peak happens within 2 to 12 hours (Thour & Marwaha, 2019). The most common adverse effect are dizziness, constipation, drowsiness, and headache. I would continue on the current medication and increase it to 125 mg/ day at bedtime that week. I would instruct the patient to increase the intake to 200mg/day in the following week, which should be taken an hour earlier than starting tonight.
I would also advise the patient to call the office 3 days in the morning for a report. If the patient reports that the pain is fading away, the medication plan is effective. Therefore, the decision point seems to be helping the patient in pain control. The third decision point is to continue with the current amitriptyline dose of 125 mg/day. In addition, I would encourage the patient to have a counselor for life coach therapy for both exercise and dietary behavior. I will also consider warning the patient against adverse effects such as cardiovascular risk and ensure that I monitor the cardiac function and the serum levels.
I would also not on the effect on the blood pressure and mood changes. I would discourage reducing the dose and adding Gabapentin which is not applicable. Gabapentin helps in relaxing the muscles, thus an anticonvulsive medication (Manville & Abbott, 2018). Gabapentin has a chemical structure that consists of the cyclohexyl group (Manville & Abbott, 2018). It consists of a half-life estimated between 5 to 7 hours, and the body takes two days to eliminate it from the system.
I expected the patient health to improve after using amitriptyline and reduce the pain on a scale of 10 points. The drug effectively manages insomnia and anxiety while it also helps in neuropathic pain management. Therefore, more to increasing the patient dosage, I would consider encouraging the need for peer support groups, pain care specialists, and rehabilitation psychology. Physical therapy is essential in balancing the patient’s mobility.
After 3 months, the patient returned to the hospital walking without any support and reported a reduction of pain to between 4 to 10 point scales. The patient was joyous and willing to continue with the treatment plan, which reduces pain. The assessment result on blood pressure was 120/84mm/hg, while the pulse rate was 86 beats/min. The patient was aware that the pain did not disappear completely b
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