Case Study: A Caucasian Man with Hip Pain
Name
2022
NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology
Walden University
CRPS is a multifactorial condition frequently occurring after an injury, and has neurogenic
clinical characteristics, nociceptive sensitis, vasomotor dysfunction, and mala-adaptive neuro
flammatory syndrome (Birklein and Dimova, 2017). This disease is often known as reflective
sympathetic dystrophy syndrome. Stahl (2013) is of the opinion that CPRS is caused by central
or peripheral nervous dysfunction. He suggests pain receptors in the affected area of the body
respond to catecholamine, a group of messengers of nervous system causing extreme pain,
swelling, limited movement and changes in the skin and bones in the affected limb.
He has had multiple x-rays, MRIs and CT scans made on him to try to repair that. After all, none of
the doctors he met wanted to remove hips because they thought he was too young to do so.
According to one neurologist, the patient had a disorder known as sympathetic reflex syndrome,
which caused the family doctor not to want to refer the patient to psychiatry. The patient preferred
not to use a wheelchair but to use crutches.
Decision #1Decision Selected
My first decision was to use amitriptyline 25 mg po QHS and titrate up to 200 mg per day.
Although the consumer refuses to be depressed, it seems clear that he is depressed or is at risk of
depression as he sees how hard life is plus the negative impact of RSD. Amitriptyline is used as
an ideal alternative for treating nerve pain and the treatment of depression (Emedexpert.com,
2008). I was hoping to get there because Amitriptyline is considered to be a effective cure for
chronic pain and I expected that in the first four weeks the pain for the client will be reduced to
6/10 or lower (the clinical action of Amitriptyline does not usually begin immediately, but it
mostly takes between 2 and 4 weeks). The drugs have sedating properties that support the sleep of
the patients (Stahlonline-cambridge-org.ezp.waldenulibrary.org, 2018).
Decision #2
My second decision is to maintain amitriptyline and raise the dosage to 200 mg daily
(Laureate Education, 2016a). I will advise him to take the medicine for 3 consecutive days and
pay attention how it reacts in the morning (Laureate Education, 2016a).
The change of drug administration period worked well after 4 weeks, since he does not
report tiredness especially in the morning (Laureate, 2016a). The pain level is reduced to 4
(Laureate education, 2016a). However, the patient has visibly increased weight by 5 pounds
(Laureate Education, 2016a). He can walk without the support of crunches though he is worried
about gaining in weight (Wolters Kluwer Clinical Drug Information, 2018a).
Decision #3
My third decision consisted of sticking with the current Elavil 125 mg dose per day,
(Laureate Education, 2016a).
It will be better to proceed with the same dosage and advise him on healthy eating habits
and exercise habits as well as on a life coach (Laureate Education, 2016a). I hoped that this
decision would help him manage his benefit by recommending him a life-coach and a medicinal
pain management.
Conclusion
Before each medicine was prescribed, it was important to research. I thought that the
amitriptyline was the right treatment for this patient's discomfort. Hearing his concern and
referring him to the life coach was significant. This was not because he had an answer and
reduced his discomfort that I should reduce the drug dosage.
References
Laureate Education (2016a). Case Study: A Caucasian man with hip pain [Interactive media
file]. Baltimore, MD: Author
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/07/mm/
complex_regional_pain_disorder/2.html
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
applications (4th ed.). New York, NY: Cambridge University Press.
Wolters Kluwer Clinical Drug Information (2018a). Amitriptyline.
https://www.merckmanuals.com/professional/appendixes/brand-names-of-some-
commonly-used-drugs?startswith=a#section_22
Wolters Kluwer Clinical Drug Information (2018b). Milnacipran.
https://www.merckmanuals.com/professional/appendixes/brand-names-of-some-
commonly-used-drugs?startswith=m#section_3
