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Running head: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS

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DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS

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Decision Tree for Neurological and Musculoskeletal Disorders

Summary of the patient case

This is a 43-year-old white male came to the facility with a chief complain of pain. He is being helped through a set of clutches due to his ambulation and based on the interview; the patient reports that he has been sent by the family doctor for the psychiatric evaluation since the doctor felt that the pain was coming from the head and as an excuse to get narcotics to get high. The pain started 7 years ago after the sustenance of the fall when working.

Diagnosis: Complex regional pain disorder

This is a chronic pain disease thus is associated with the greater intensity of the nerve impulses being sent to the regions that has been affected. This condition occurs is caused by the dysfunction in the central or peripheral nervous systems. The exact cause of the condition is still not well understood, but medications are being prescribed for this condition (Nisenbaum, 2016).

The decisions, what was expected to be achieved, and the differences in the decisions

Decision one

Begin 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

This treatment is important since it helps in dealing with severe cramping of the extremity and assisting in the reduction of the nerve pain which is common for patients having this kind of condition. This drug is also helping in dealing with pains that are felt in the hands and arms and reduction in the bodyweight which also increases the levels of pain felt in the joints. The expectation with this decision is the overall reduction in the pain in the body being experienced by the patient. When compared to other decisions, the patient is expected to overcome the pain within a short after taking the medication (Nisenbaum, 2016).

Decision two

Giving Amitriptyline 25 mg PO QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day

This drug is important since it allows the patient to be free from pain and sleep well at night. It prevents the patient from waking up at night since it assists in reducing the neuropathic pain. It is used as a replacement for the narcotic pain medicines which was previously being used by the patient based on the claim that was made by his physician. Therefore, it is expected that the patient will stop using the narcotic drug as a pain killer like in the previous case, but instead rely on this drug to help in dealing with pain. When compared to other decisions, the patient is expected to sleep well as opposed to the oversleeping incidence that was experienced when using the hydrocodone. It is also expected that the patient will have a reduction in the symptoms that be linked to the intake of the narcotic drug to relieve pain (Gupta, 2018).

Decision three

Prescribing Neurontin 300 mg PO BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed

Apart from the pain being experienced by the patient, he is also suffering from the sensory symptoms in the diagnosed disease. It also helps in dealing with the postherpetic neuralgia as well as the body temperature disturbance issues. It is therefore expected that the use of this medication will help in relieving pain as well as the postherpetic neuralgia symptoms associated with the disease. The variation of this decision from others is that the drug is used to deal with the postherpetic neuralgia that might have occurred as a result of damages to the nerve fibers due to this disease or any other undetected condition such as viral infection (Gupta, 2018).

Whether the decisions are supported by the evidence-based literature

A study by Wertli et al (2014) was aimed at examining the effectiveness of all agent classes that were examined in a randomized clinical trial of CRPS 1 and giving a rank order of different medicines based on the duration of the illness. The outcome of this research reveals that the radical scavenger’s mannitol and the anticonvulsant gabapentin had identical efficacy as compared to placebo in the reduction of pain (Wertli, Kessels, & Roberto, 2014).

Most of the heterogeneous class of medications is used for the neuropathic and acute pain conditions and they include melatonin, gabapentin, and the low dose amitriptyline. These drugs are used as adjuvant analgesics in the management of the pain (Friedrichsdorf, Giordano, Dakoji, Warmuth, Daughtry, & Schulz, 2016).

References

Friedrichsdorf, S. J., Giordano, J., Dakoji, D. K., Warmuth, A., Daughtry, C., & Schulz, C. A. (2016). Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles, and Joints. Children, 3 (4), 42.

Gupta, G. (2018, June 20). Complex Regional Pain Syndromes Treatment & Management. Retrieved January 4, 2020, from Medscape: https://emedicine.medscape.com/article/1145318-treatment

Nisenbaum, R. (2016). Complex Regional Pain Syndrome After Knee Arthroscopy. Proceedings of UCLA Healthcare, 20.

Wertli, M. M., Kessels, A. G., & Roberto, S. G. (2014). Rational Pain Management in Complex Regional Pain Syndrome 1 (CRPS 1)—A Network MetaAalysis. Pain Medicine, 15 (9), 1575-1589.