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Treatment of Chronic Pain Pain is a distressful sensory experience emanating from tissue, bone, or nerve damage in any body part. Pain is considered a symptom of underlying health conditions (Yong, Nguyen, Nelson & Urman, 2017). For instance, people with complex neuropathic pain syndrome experience excruciating pain in the legs, hands, and hips (Freedman, Gehret, Young & Kamen, 2017). Treatment of pain involves administration with pain-relieving medications and physiotherapy. These interventions, nonetheless, do not address the cause of pain. Clinicians conduct a comprehensive assessment of the client’s physical health and medical history to identify the cause of pain. Clinicians can order various diagnostic tests, including X-ray, sweat test, bone scan, and thermography, to detect abnormalities leading to pain (Forbes & Watt, 2020). Clients are encouraged to seek medical intervention once they experience unmanageable pain. Clinicians initiate early treatment once a diagnosis is confirmed to facilitate recovery and improved quality of life. This discussion explores the treatment plan for an adult with complex neuropathic pain syndrome.
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Case Summary The client is a 43-year-old Caucasian male complaining of pain. The client has a history of a fall that occurred seven years ago. The patient suffered from a torn hip, but the physician ruled out a hip replacement due to the client’s young age. He complains of strange symptoms, including cramping nth limbs and cooling of the legs. The neurologist diagnosed the client with Reflex sympathetic dystrophy. The family doctor disagreed with this diagnosis claiming that the client was depressed and needed to see a psychiatrist since the pain was all in mind. The client experiences mild depressive episodes due to various life challenges. He was previously administered hydrocodone but rarely takes it due to adverse effects. The patient did not present with a major psychological disorder. The therapist confirmed the client was suffering from complex neuropathic pain syndrome. Treatment Decision Point I Choice: Client to start 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 after that Rationale: Savella is an antipsychotic medication also used in the treatment of depressive disorders. The FDA has approved this medication for chronic pain conditions such as fibromyalgia. Evidence shows that this medication effectively lowers the pain threshold (Agrawal, Faruqui & Bodani, 2020). Its action on the nervous system inhibits serotonin and norepinephrine reuptake, thus decreasing the sensitivity to pain (Yasaei, Peterson & Saadabadi, 2020). Anticipated outcomes: Savella was expected to reduce pain intensity in the client, subsequently improving mobility.
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The variation between expected and achieved results: After a month of taking the medication, the client reported that the pain was more manageable. Mobility had also improved significantly. However, he pointed out that pain intensity is greatest in the morning but decreases as the day progresses. He also reported several side effects, including sweating, nausea, discomfort, and sleep problems. Treatment Decision Point II Choice: client to carry on with Savella, but a dose to be reduced to 25mg twice daily. Rationale: Savella was maintained since the client reported remarkable improvement in pain management and mobility. The therapist lowered the dose to reduce the risk of side effects. Evidence shows that a lower dose of Savella does not produce side effects like sweating and nausea, irregular heartbeats, sleep problems and discomfort (Yasaei, Peterson & Saadabadi, 2020). Anticipated results: Savella dose reduction was intended to eradicate pain without producing side effects. Difference between actual and anticipated results: The treatment plan did not produce better health outcomes. The client reported that pain intensity had increased. He rated the pain at 7/10. He was also totally dependent on crutches for mobility. The client noted that his condition had worsened. He was worried that his condition was deteriorating rather than improving. Whereas Savella dose reduction helped control side effects, it was not effective in pain control Treatment Decision point III Choice: To reduce Savella to 12.5 mg orally BID and start Celexa 10 mg orally daily Rationale: Savella was reduced to manage side effects. However, at a lower dose, Savella cannot effectively control pain. Citalopram 10mg was added to boost pain control. Citalopram is
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an SNRI. It boosts neurotransmitter levels, thus, lowering the pain threshold (Belinskaia et al., 2019). It also helps to reduce depressive symptoms. The dosage was kept low to avert the risk of adverse effects. Anticipated results: The therapist intended to improve mobility and reduce pain intensity from 7 to less than 3/10. The plan also aimed to eradicate side effects and improve comfort. Comparison of projected and achieved results: The anticipated treatment goals were achieved. The client reported that pain intensity had decreased to 3/10. He was also able to move without crutches. He did not report any side effects.
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Ethical Considerations A set of ethical principles guide the treatment of chronic pain conditions. The principle of autonomy, for instance, requires nurses to educate the client about the condition and available treatments (Schatman, 2016). The therapist has to inform the client that antipsychotic medications are used in treating chronic pain, and this does not mean one is presenting with a psychiatric condition. The therapist should use a lower dosage of antipsychotic medications to reduce side effects in line with the principle of non-maleficence (Schatman, 2016). The therapist must maintain the privacy and confidentiality of patient data. Conclusion Chronic pain is a devastating health condition that leads to discomfort, immobility, and low quality of life. Clinicians use pain relievers to treat painful conditions. However, chronic pain required strong mediations. Antipsychotic medications are used since they have strong analgesic properties.
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References Agrawal, N., Faruqui, R., & Bodani, M. (Eds.). (2020). Oxford Textbook of Neuropsychiatry. Oxford University Press. Belinskaia, D. A., Belinskaia, M. A., Barygin, O. I., Vanchakova, N. P., & Shestakova, N. N. (2019). Psychotropic drugs for the management of chronic pain and itch. Pharmaceuticals, 12(2), 99. https://doi.org/10.3390/ph12020099 Forbes, H., & Watt, E. (2020). Jarvis's Health Assessment and Physical Examination-E-Book: Australian and New Zealand. Elsevier. Freedman, M., Gehret, J., Young, G., & Kamen, L. (2017). Challenging Neuropathic Pain Syndromes: Evaluation and Evidence-Based Treatment. Elsevier Health Sciences. Schatman, M. E. (Ed.). (2016). Ethical issues in chronic pain management. CRC Press. Yasaei, R., Peterson, E., & Saadabadi, A. (2020). Chronic Pain Syndrome. https://www.ncbi.nlm.nih.gov/books/NBK470523/ Yong, R. J., Nguyen, M., Nelson, E., & Urman, R. D. (Eds.). (2017). Pain medicine: an essential review. Springer.