Treatment For Chronic Central Neuropathic Pain in People With Multiple Sclerosis Discussion

Patient Case Study Summary

The case study is a 26-year-old female who has been diagnosed with multiple sclerosis. She has some concerns about her condition ahead of seeing her physician for a follow-up. Multiple sclerosis is an autoimmune disease of the central nervous system associated with chronic inflammation, demyelination, and loss of neuronal function. The disease usually affects people between the ages of 20-40 years and can range from stable chronic disease to a rapidly evolving and debilitating condition. The neurologic deterioration from MS can result in several complications including muscle weakness and spasms, tremors, facial pain, hearing loss, and urinary incontinence.

The management of MS includes drugs used for the management of complications such as chronic neuropathic pain (Garg & Weinstock-Guttman, 2019). Chronic pain is a common problem associated with multiple sclerosis and its management requires a multidisciplinary approach (Sullivan & Domingo, 2017).

ORDER HERE A PLAGIARISM-FREE PAPER 

Decision Point One- Savella 12.5 mg orally O.D day 1; then 12.5mg BD on days 2 and 3; followed by 25mg BD on days 4-7, followed by 50mg BD thereafter (Hilda Onuțu et al., 2019). Treatment For Chronic Central Neuropathic Pain in People With Multiple Sclerosis Discussion

Reason for Decision selection and Expected Outcome: The patient has been diagnosed with multiple sclerosis. One of the significant problems associated with MS is neurological and musculoskeletal complications presenting as chronic pain syndromes. Savella is a selective serotonin and norepinephrine reuptake inhibitor (SNRI), which increases the level of neurotransmitters available for reuptake by the brain hence reducing pain. This drug has been recommended for chronic pain management such as in this case (Hilda Onuțu et al., 2019). The expectation is a reduction in pain perception, which will improve the patient’s quality of life.

Difference between expected and Actual outcome: The patient returns after 4 weeks and reports the pain to have reduced to a lower level but would beA happy with a pain level of three. She also reports bouts of sweating, sleep disturbance, and a feeling of butterflies in her chest. These are known side effects of Savella that could be managed by dose reduction.

Decision Point 2- Continue Savella but lower the dose to 25mg BD

Reason for selection and expected outcome: Since Savella has relieved the pain, maintaining the treatment is a good decision. However, lowering the dosage would be needed to minimize the adverse effects of the drug. The expected outcome is a continuation in pain management and a reduction of the side effects in the following weeks.

Difference between expected and actual outcome: Patient comes in after 4 weeks with no palpitations and sleeping at night, but complains of waking up frequently due to pain. She reports the pain level at a seven. All could be an effect of the dose reduction. Treatment For Chronic Central Neuropathic Pain in People With Multiple Sclerosis Discussion

Decision point 3- Modify dosage of Savella to 25 mg P.O in the morning, and 50 mg P.O at bedtime

Reasons for selection and expected outcome: The patient’s pain syndrome is a neurological complication of multiple sclerosis and thus, it will not completely respond to treatment. My next step will be to explain this to her and consider other non-pharmacological options for pain control (Murnion, 2018). Since she initially responded well to the initial dose, the best option would be to lower the dose when the pain is more bearable and increase it at night so that she can sleep better, while having fewer side effects as well.

Difference between expected and actual outcome: The patient comes back after 4 weeks and reports a pain level of four but would love to have it lower. She now has normal blood pressure and pulse rate. The best option at this point is to advise her to find other ways of coping and living with this achievement since further dose adjustment would not be practical (Sullivan & Domingo, 2017). She can make use of other additional treatment modalities such as physiotherapy and yoga to help cope with the minimal pain.

Conclusion

Multiple sclerosis is an autoimmune condition resulting from immune system destruction of the central nervous system. This can lead to neurological and musculoskeletal complications such as chronic pain. The pain due to nerve destruction is not treatable, thus management involves the use of drugs that lower the pain level to a level that can be tolerated to improve the patient’s quality of life (James et al., 2020). Savella is an SNRI, which is approved for the management of chronic pain such as in multiple sclerosis and in fibromyalgia.

References

Garg N., & Weinstock-Guttman B. (2019). Treatment of pain, paresthesias, and paroxysmal disorders in multiple sclerosis. Multiple Sclerosis Therapeutics, 785-802. https://doi.org/10.3109/9780203639115-52

Gupta, H., Girma, B., Jenkins, J. S., Kaufman, S. E., Lee, C. A., & Kaye, A. D. (2021). Milnacipran for the treatment of Fibromyalgia. Health Psychology Research, 9(1). https://doi.org/10.52965/001c.25532

Hilda Onuțu, A., Sebastian Dîrzu, D., & Petrișor, C. (2019). Serotonin reuptake inhibitors and their role in chronic pain management. Serotonin. https://doi.org/10.5772/intechopen.80711

James, E., Young, C. A., Gibbons, E. L., Shueb, A., & Tur, C. (2020). Pharmacological treatment for chronic central neuropathic pain in people with multiple sclerosis. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd013599

Murnion, B. P. (2018). Neuropathic pain: Current definition and review of drug treatment. Australian Prescriber, 41(3), 60-63. https://doi.org/10.18773/austprescr.2018.022

Sullivan, A., & Domingo, S. (2017). Interdisciplinary treatment of patients with multiple sclerosis and chronic pain. Nutrition and Lifestyle in Neurological Autoimmune Diseases, 213-219. Treatment For Chronic Central Neuropathic Pain in People With Multiple Sclerosis Discussion

Case Study:
Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.Treatment For Chronic Central Neuropathic Pain in People With Multiple Sclerosis Discussion

Learning Objectives
Students will:

Evaluate patients for treatment of neurologic and musculoskeletal disorders
Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders. Treatment For Chronic Central Neuropathic Pain in People With Multiple Sclerosis Discussion

Photo Credit: KATERYNA KON/SCIENCE PHOTO LIBRARY / Science Photo Library / Getty Images

To Prepare
Review the interactive media piece assigned by your Instructor.
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
By Day 7 of Week 8
Write a 1- to 2-page summary paper that addresses the following:

ORDER HERE NOW

Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
You will submit this Assignment in Week 8. Treatment For Chronic Central Neuropathic Pain in People With Multiple Sclerosis Discussion