Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

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Running Head: A CAUCASIAN MAN WITH HIP PAIN 1

A CAUCASIAN MAN WITH HIP PAIN 3

A Caucasian Man with Hip Pain.

Student’s Name.

Institution.

I received a client who complained of pain on the right hip which he had sustained after falling while in his place of work seven years ago. He had numerous x-rays, CT scan and even MRIs tests done on him. None of the doctors he visited had agreed to perform hip replacement citing that he is too young for it. One neurologist suggested that he suffered from a reflex sympathetic syndrome which the family doctor citing there is nothing of such sought. The family doctor referred him to psychiatry. The patient refused the advice of using a wheelchair. He would rather use crutches to walk rather than use a wheelchair. I took the following decisions:

Decision 1

Following the evaluation, i did on the patient. I decided to go with choice 1 amongst the 3 choices. This is because Savella helps in reducing pain to the patient to a manageable level and improved physical activities (Chen, 2013). A combination of Amitriptyline and Neurontin helps to treat mental illness as the patient exhibited some level of depression which had been diagnosed by the neurologist earlier. Anticipated results included reduction of pain in the first week and improved physical activities. However, there was a variation between the expected and actual result. Though the pain had reduced, it was bad during the night. However, on the positive side, the patient sometimes needed not to use crutches to walk.

Decision 2

I prescribed the patient to take Lyrica (pregabalin) 50 mg and Zoloft 50 mg. this option has less side effect as compared choices. The expected results were Lyrica was to target the chemical neural so as to reduce the pain experienced by the patient (Schjøtt, & Bergman, 2014). Zoloft was expected to act as antidepressant so as to improve the chemical balance in the brain through improved communication between nerve cells and central nervous system. However, there was a deviation between the expected results and the observed results. After four weeks the pain had become much worse with a scale of 7-10. The patient was still using crutches to walk. The pain frequently affected the patient during the night. Though the patient denied experiencing depression, he seemed very sad. The patient body seemed not to respond to the prescribed drugs

Decision 3.

I prescribed the patient start tramadol 50 mg and Celexa with a change of Savella to 25 mg in the morning and 50 mg during the night which would later be reduced to 12.5 mg. the reason for choosing this was aided by the fact that the combination of both Savella and tramadol would help reduce pain. Expected result was reduced pain to significant level and Celexa was expected to reduce mental depression (Bar‐Yam, 2016). However, the patient did not respond to the drugs prescribed as the pain seemed to be neuropathic. The patient must be made aware that he must expect some level of pain on a daily basis. The pain may reduce due to the fact that tramadol does not work well with other pain relieving drugs such as Savella.

It's important to review Ethical issues and consideration when prescribing a patient with a drug (Elwyn, Frosch, Thomson, et al 2012). It's important to first evaluate the patient thoroughly to avoid the problem of erroneous diagnosis of the patient. It's also important to review which procedures to use when treating the patient and telling the patient the whole information on his/ her health. For example in our case the client was a pain was neuropathic and it was certain that he would experience some level of pain on a daily base.

In conclusion, the first choice was the better option as the patient stated that pain reduced to a scale of 4-10. He experienced less pain. The other two choices pain did not reduce. This may, however, be attributed it had to eliminate the whole pain. The client was to expect some pain on a daily basis.

References.

Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., ... & Edwards, A. (2012). Shared decision making: a model for clinical practice. Journal of general internal medicine,

Chen, A. (2013, August). Patient Experience in Online Support Forums: Modeling Interpersonal Interactions and Medication Use. In ACL (Student Research Workshop

Bahmani, M., Rafieian-Kopaei, M., Hassanzadazar, H., Saki, K., Karamati, S. A., & Delfan, B. (2014). A review on most important herbal and synthetic antihelmintic drugs. Asian Pacific journal of tropical medicine

Bar‐Yam, Y. (2016). The limits of phenomenology: from behaviorism to drug testing and engineering design. Complexity, 21(S1),

Levin, G. M., & Ellingrod, V. L. (2012). P-glycoprotein: why this drug transporter may be clinically important. Current Psychiatry, .

Schjøtt, J., & Bergman, J. (2014). Joint medicine-information and pharmacovigilance services could improve detection and communication about drug-safety problems. Drug, healthcare and patient safety,