Complex Regional Pain Syndrome Assignment Essay

Complex regional pain syndrome is a type of pain where a person experiences severe pain that is mostly caused by injury which results in long lasting pain that normal and it mostly affects the arms or legs (Birklein & Dimova, 2017). The injury results from damage to the soft tissues which makes it more severe that expected. Some of the causes of complex regional pain disorder can include amputation or surgery (Urits et al., 2018). The purpose of this paper is to discuss a case study of a patient suffering from complex regional pain disorder and provide an appropriate therapy. Complex Regional Pain Syndrome Assignment Essay

Summary of the Case Study and Decisions Selected

The case study involves a 43-year old white man who presents with the chief complaint of pain which started 7 years ago after a fall at work. The fall incident led to an injury on his right hip and the client further reported cooling of the extremity and was diagnosed with complex regional pain syndrome. The decisions selected for the particular case are as follows; the first decision was Savella 12.5 mg 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 thereafter. The second decision was to Continue with current medication but lower dose to 25 mg twice a day. The third decision was to change Savella to 25 mg orally in the morning and 50 mg orally at bedtime.

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Evidence Based Literature to Support on the Decisions Selected

Milnacipran (Savella) is one of the three main drugs that have been approved by the FDA for the treatment of complex regional pain syndrome (Ellingrod, 2017). Milnacipran is a serotonin-norepinephrine reuptake inhibitor (SNRI) which is used for the treatment of chronic neuropathic pain and fibromyalgia (Keks et al., 2018). Milnacipran is effective in the treatment of pain as a result of fibromyalgia with a dose of at least 100 mg to 200 mg. Sudden withdrawal of milnacipran is associated with withdrawal symptoms hence, withdrawal should be gradual (Henssler et al., 2019). Complex Regional Pain Syndrome Assignment Essay

Expectations for the Decisions Chosen

With the point one decision, my expectations were that the pain experienced by the patient would decrease which means that the patient would walk with minimal difficulty and have an improvement in performance in daily activities. For decision point two, the patient has improved in terms of symptoms because he reports to the facility without using crutches and states that his pain is at 4. Besides, the patient has improved sleep. However, discontinuing Milnacipran will lead to withdrawal symptoms hence, reduction of the dose. The point of reducing Milnacipran to 25 mg is because the drug is only part of the treatment regime and should not be taken as the only option, the dose should be reduced while introducing other non-pharmacological interventions.

Actual Results from the Decisions

The results for of the first decision were very close to my expectations because the patient returned in four weeks without the use of crutches and stated that his pain was at 4 out of 10, which was very impressive. Besides, the patient reported to have improved sleep. Also, the patient is oriented to the future a good sign of progress. At decision point two, the patient reports of worsening of his symptoms to 7 out of 10 and frequently waking up at night. The last decision that was reducing the dosage helped the patient manage his activities and overcome the symptoms of withdrawal. Complex Regional Pain Syndrome Assignment Essay

References

Birklein, F., & Dimova, V. (2017). Complex regional pain syndrome–up-to-date. Pain reports, 2(6).

Ellingrod, V. L. (2017). When to prescribe antidepressants to treat comorbid depression and pain disorders. Current Psychiatry, 16(1).

Henssler, J., Heinz, A., Brandt, L., & Bschor, T. (2019). Antidepressant withdrawal and rebound phenomena. Deutsches Ärzteblatt International, 116(20), 355.

Keks, N. A., Hope, J., Keogh, S., & Copolov, D. L. (2018). Milnacipran: serotonin-noradrenaline reuptake inhibitor approved for fibromyalgia may be a useful antidepressant. Australasian Psychiatry, 26(5), 537-540.

Urits, I., Shen, A. H., Jones, M. R., Viswanath, O., & Kaye, A. D. (2018). Complex regional pain syndrome, current concepts and treatment options. Current pain and headache reports, 22(2), 1-9. Complex Regional Pain Syndrome Assignment Essay