Caucasian Man with Hip Pain Discussion

Pain often indicates the presence of a problem in the body. It can be really devastating and disturbing depending on the location, severity and nature. The three main types of pain include sensory hypersensitivity, neuropathic pain and nociceptive pain. Extreme pain can cause increased suffering and death associated with shocks and unconsciousness.  However pain can be managed with medication even though the root cause of the pain needs to be determined for effective treatment. As such, this paper seeks to explore the assessment and treatment of pain using a case study involving a Caucasian man with hip pain (Laureate Education, 2016a). It also identifies the ethical considerations that affect treatment plan and communication with the clients. Caucasian Man with Hip Pain Discussion

Decision #1

I selected Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day

Amitriptyline 25 mg is used for the treatment of depression and other mood and mental disorders. I selected this decision because the client appears to be depressed considering that he feels helpless at times even though he denies it (Laureate Education, 2016a). Another reason is because the drug is used to relieve pain at low dosages the reason why it was titrated to a maximum dose of 200mg daily (Stahl, 2014b). This medication increases the amount of serotonin neurotransmitters in the brain and thus acts as a first line treatment antidepressant for chronic pain.

With this decision, I was hoping to manage the patient’s pain and improve his quality of life. On the other hand, I was seeking to manage his mental disturbances which often lead him to the dumps. Its application in the treatment of neuropathic pain has been reported by evidence-based research (National Institute of Neurological Disorders and Stroke, 2016). This dosage also minimizes the chances of having adverse side effects on the patient which makes recovery faster. It was also expected that the curling of the toes would stop. Caucasian Man with Hip Pain Discussion

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The difference between what was expected and what was achieved is quite minimal. For instance; the client came back after four weeks reporting the reduction of pain in a bigger range than the expected. He was also able to walk occasionally without crutches which weren’t expected to take place within a short time. These results demonstrate a more positive outcome of the medication than the expected. Another difference is that the curling of the toes had reduced and not eliminated as expected. The difference was due to the long time taken by the medication to initialize the effects in the body. The low dosage could also have delayed some of the expected results.

Decision Point Two

Continue current medication and increase dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning

This decision was selected to help achieve the optimum dosage for the client in order to attain maximum results. The drug was also tolerated well by the patient and therefore, considering another drug change could have introduced new side effects and prolonged the recovery process. The reason for drug administration at bedtime sought to manage the side effects which include drowsiness which could affect the patient’s daytime activities (Stahl, 2014b). Calling the office on three days allows follow up and monitoring of the patients progress during the treatment. It will also help determine the tolerance of the patient to the drug.

This decision sought to achieve an optimum dosage for the patient. This helps in improving his recovery process. Moreover, the increase of medication dosage was hoping to reduce the pain to at the acceptable scale rating of 3 and improve the quality of the patient’s life (Stahl, 2014b). In addition, it sought to manage throbbing in the right leg of the client which he complained to have been affecting him adversely. The problem of curling toes was also being treated by the increase of this dosage.

The difference experienced is that the client reports a pain level of 4 contrary to the expected level of 3. A weight gain was observed by the client also. The difference resulted from the side effects of 125 mg of amitriptyline which includes weight changes (American Psychiatric Association, 2013). Caucasian Man with Hip Pain Discussion

Decision 3

Continue the current dose of Elavil of 125 mg per day; refer the client to a life coach who can counsel him on good dietary habits and exercise

I selected this decision because the client complained of weight gain and hence exercise and dietary advice would be of great help to him (Stahl, 2013). The continuation of drug was done because; the patient had demonstrated pain control and hence it was essential for maintenance and complete recovery.

This decision sought to achieve a complete recovery of the patient. This includes the elimination of pain and curling of the toes, change in the color of the leg and numbness as well as the side effects. Diet counselling also sought to manage the client’s weight and prevent the increase (American Psychiatric Association, 2013).

This decision did not present any difference from what was expected.

Ethical considerations

Ethical considerations associated with communication and treatment of this patient includes confidentiality. The client’s confidentiality should be maintained during communication for privacy purposes. Additionally, the autonomy of the client during treatment should involve respecting of their rights and as well as involving them in decision making after giving them consent of the treatment plan (American Psychiatric Association, 2013).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Laureate Education (2016a). Case study: A Caucasian man with hip pain [Interactive media file]. Baltimore, MD: Author

National Institute of Neurological Disorders and Stroke. (2016). Pain: Hope through research. Retrieved from http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#3084_2

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press

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Caucasian Man with Hip Pain Discussion