Introduction
Complex regional pain syndrome is a debilitating condition that affects the limbs and is likely to be induced by trauma or surgery. Apart from complicating the entire recovery process, it tends to impair the psychosocial and functional well-being of an individual. It’s characterized by vasomotor abnormalities, hyperalgesia, , and allodynia. The pain that a patient experiences is often disproportionate to the degree of tissue injury that occurs and may persist beyond the anticipated period required for tissue healing (Stanton-Hicks, 2018). The major goals of therapy are: to ensure pain relief, to restore functioning and psychologically stabilize a patient.
Many drugs are often used in pain management to improve functional status. However, mental health practitioners should ensure that the choice of drugs promotes compliance and have fewer side effects. This paper discusses the management of a 43-year-old who presented with complex regional pain disorder. In his management, three decisions are to be made regarding the most effective medications, expected outcomes, , and actual outcomes. A description of the ethical issues when engaging clients with complex regional pain disorder and their families will also be provided.
Decision #1
Decision Selected
Start Savella 12.5 mg orally 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 thereafter
Reasons for Selecting This Decision
Patients with regional pain disorder have a low pain threshold which may be caused by changes in the central nervous system. These changes cause a patient to be more sensitive to pain due to wrong neurotransmitter levels in the brain. As selective norepinephrine and serotonin reuptake inhibitor (SNRI) that has an equal effect on both neurotransmitters, Savella is an NMDA antagonist that works on nerve endings to produce analgesic effects (Stanton-Hicks, 2018). It promotes the reuptake of the neurotransmitters in the brain thus easing the pain, reducing fatigue and promoting memory.
Amitriptyline, a tricyclic antidepressant that has proven to be effective in the management of neuropathic pain off label could also be a good option (Benzon, Liu & Buvanendran, 2016). However, it has a side effect of drowsiness and dizziness that the client initially stated clearly that he didn’t like. Therefore, prescribing this medication for a start might only trigger non-compliance.
Neurontin, also referred to as gabapentin, is an anti-epileptic / anticonvulsant, is used in for nerve pain relief. Therefore, it could also be a good option for the management of this patient. However, it also has the side effects of drowsiness and in high doses, results in extreme somnolence and drowsiness (Finnerup, et al., 2015). Since the patient expressed his dislike for the side effect of feeling sleepy from the start, prescribing it would only lead to non-compliance.
Expected Outcome
By starting the patient on Savella, it was expected that his pain will significantly reduce to 3 on a scale of 1-10 and be able to walk without support. It was also expected that he would resume to a normal work routine and be able to perform activities of daily life will very minimal or no assistance (Stanton-Hicks, 2018). His mood would be happy or joyous and he would have a stable effect.
Difference between Expected outcome and Actual Outcome
The client returned to the clinic after four weeks walking without crutches but minimally limping. He reported that the main was more manageable and he was able to walk around with no assistance. However, he noted that the pain was worse during the morning hours and got better as the day progressed. On a scale of 1-10, his pain was reportedly 4 but admitted that he could be able to live and tolerate a level of 3. The client also noted that he occasionally experienced bouts of sweating that he couldn’t explain with some sleep disturbance. An assessment revealed that he had a blood pressure of 147/92mmhg and a pulse of 110 beats/ min. He was still future-oriented and denied homicidal/suicidal ideation. One of the major side effects of Savella is heart palpitations (Finnerup, et al., 2015). It is for this reason that the patient experienced bouts of sweating, sleep disturbance and had a high blood pressure. Reducing the dosage can help to minimize this side effect.
Decision #2
Decision Selected
Continue With the Current medication but red
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