Just as pronounced, the complex regional pain disorder is a relative chronic pain health issue that usually occurs after a person has sustained an injury. Although there is no much evidence on its cause, it is believed that the condition is caused by damage to the peripheral and central nervous system. 2 Notably, the central nervous system is one of the parts of the nervous system and it primarily consists of the brain and the spinal cord while the peripheral nervous system is the division of nervous system containing all the other body nervous that are outside the CNS. CPRS is usually characterized by pain and changes in skin color in the affected part of the body. its symptoms usually vary in severity where some cases are mild while others are severe may not recover. According to statistics, CRPD affects approximately 200, 00 persons in the united states (den Hollander et al., 2016). 3 Notably, life with CRPD is a long term and in most cases improves with medication and psychotherapy. For this reason, this paper seeks to explore a case study involving a male patient who is plagued by pain as a result of CRPD.

4 Decision #1 (Savella 12.5 mg once daily on day 1; 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) Reason Savella is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) that was approved by the FDA for clinical treatment of chronic pain in muscles, ligaments, tendons, and other supporting tissues (Urits et al., 2018). 5 It works by increasing the levels of neurotransmitters which brings a balance in the brain hence ease pain and reduce fatigue. 6 The recommended dosage for Savella is 100 mg per day over one week (Muehlbauer & Vieira, 2017). However, it is also advisable to start the dose lower in certain cases. In our case, I decided to start with a lower dosage because the clients have a history of non-compliance. 6Therefore to promote medication adherence, it is wise to start with a lower dose. 7 Notably, starting the dose lower assures the patient of limited side effects.

Hoping Since the medication is approved by the FDA in treating pain, I was hoping to reduce the client’s pain to manageable levels. Am also expecting to achieve this with the least possible side effects. By starting the dose lower, I will be able to observe its performance and adjust it accordingly.

3 Results After four weeks the client reports to the clinic for a follow-up. He comes to the office without clutches but limping a bit. 8 He reports that the pain has been manageable since he started taking the drug. The pain scale also indicates improvement with a current reading of 4 from 9. 5 However, the patient reports some medication side effects such as sweating, increased blood pressure, lack of sleep, and elevated pulse rate.

8 Decision two (Continue with current medication but a lower dose to 25 mg twice a day) My initial decision was effective in reducing pain from 9/10 to 4/10. However, despite starting the medication at a lower dosage it still caused some side effects that potentially result in more complications. For this reason, I decided to lower the dosage to 25mg twice a day in order to reduce the side effects.

5 Hoping With this decision, I was hoping to retain the efficacy of the drug and at the same time reduce the side effects. Since the medication had proven to be effective it was not wise to change it but only adjust the dosage.

3 Results After four weeks the client reports to the clinic for a follow-up. This time he reports to the office with the use of crutches. 8 He reports that he is not doing well and rates his current pain at 7 out of 10. 6 Clearly, adjusting the dosage to 25mg twice a day had reduced the impact of the medication on pain. However, it still had some positive impact on managing pain since the pain level did not shoot back to 9. The side effects were also reduced.

1 Decision three (Change Savella to 25 mg orally in the MORNING and 50 mg orally at BEDTIME) Reason I decided to adjust the dosage since the desired results were not yet achieved. Since the client reported more pain during the night, it was prudent to increase the dosage to 50 mg to make the patient have a comfortable sleep. 5 I however maintained the morning dosage at 25mg to reduce the side effects.

Hoping Being the third and final stage of treating such disorder, I intend to reduce the pain to manageable levels while ensuring that side effects related to the medication are minimal. Notably, it is not wise to change the medication at this stage since it has proven to be effective for this condition. However, balancing the dosage is key in ensuring that the pain is managed without any medication side effects.

Ethical consideration

The ethical considerations that impacted the treatment plan and communication for this patient are confidentiality and informed consent. The patient’s information was kept private and was not disclosed to third parties. 3 Informed consent was also taken into consideration where the patient was informed on every treatment step taken.

Conclusion

Overall, it is evident that complex regional pain disorder can interfere with our normal life activities. 3 However, with a proper treatment regimen, the condition can effectively be managed. It is therefore important to seek early treatment to avoid other complications associated with the condition.

References

9 den Hollander, M., Goossens, M., de Jong, J., Ruijgrok, J., Oosterhof, J., Onghena, P.,. & Vlaeyen, J. W. (2016). 10 Expose or protect? A randomized controlled trial of exposure in vivo vs pain-contingent treatment as usual in patients with complex regional pain syndrome type 1. 11 Pain, 157(10), 2318-2329.

Muehlbauer, T. 5 G., & Vieira, K. (2017). 12 Effects of a 4-week AVACEN Treatment on Pain Perception in Fibromyalgia: An Open Label Study. 7 Fibrom Open Access, 2(124), 2.

13 Urits, I., Shen, A. H., Jones, M. R., Viswanath, O., & Kaye, A. D. (2018). 13 Complex regional pain syndrome, current concepts and treatment options. Current pain and headache reports, 22(2), 10.