Decision Tree for Neurological and Musculoskeletal Disorders
Case Study Summary
The patient is a 43-year-old male diagnosed with complex regional pain disorder, also referred to as reflex sympathetic dystrophy. He has a medical history of a hip injury, was diagnosed with complex regional pain disorder, and reports to be having severe pain and symptoms for several years. The initial treatment involved a prescription of Savella. The patient reported some improvement after four weeks but complained of side effects like poor sleep, sweating, and nausea. The dosage was decreased, but the pain worsened after the following four weeks. The decision was made to adjust the Savella dosage by giving 25mg and 50 mg in the morning and at bedtime respectively. Below, evidence support for decisions, objectives of the recommended decisions, and a difference in the decisions made and results are discussed.
Evidence-Based Support for Decisions
The clinical decision to initiate the patient on Savella is in support of evidence. Savella is a serotonin and norepinephrine reuptake inhibitor (SNRI) with N-methyl-D-aspartate (NMDA) receptor antagonist activity, suitable for neuropathic pain syndrome like complex regional pain disorder. Norepinephrine and serotonin modulate endogenous analgesic mechanisms by decreasing pain pathways that are inhibitory in the spinal cord and brain (Cho et al., 2023). Imbalance and disinhibition of serotonin and norepinephrine in endogenous ache inhibitory pathways can lead to persistent pain. A surge in serotonin and norepinephrine may increase pain signals blockage, improving pain relief. However, the specific mechanism of action is not well understood (Cho et al., 2023).
The initial improvement in pain and functionality after the first decision point is in line with the known effects of the drug. However, the following decisions, specifically the decrease in dosage and the change to 25 mg in the morning and 50 mg at bedtime, are less straightforward. Even though dose adjustment is common clinical practice, the deterioration of the patient’s pain and the start of side effects show the complexity of management of the complex regional pain disorder and the need for careful consideration of individual responses (Cho et al., 2023).
Goals of Recommended Decisions
The main goal of the decisions was to help in pain management, improve functionality, and address side effects. The first decision achieved some success, with the patient reporting increased mobility and reduced pain. However, the following decisions did not result in the desired outcome, and the emergence of side effects such as poor sleep, sweating, and nausea became additional factors to consider in the treatment plan. This resulted in a change in the dosage for the patient (Harden et al., 2022).
Expectations and Results
After the implementation of the first decision, the expected outcome was met, with the patient experiencing a decrease in pain and function improvement. However, the decisions that followed did not cause the anticipated results for the patient’s pain to deteriorate. The complexity of the condition and the unpredictable nature of individual responses to medication highlight the challenges in the effective management of this condition (Gupta et al., 2021).
In conclusion, this case shows the complexities in the management of complex regional pain disorders and the importance of multidimensional methods. Though the first decision aligns with evidence-based practices, the following changes underscore the necessity of continuous assessment, the creation of patient-centered treatment plans, and the consideration of both risks and benefits. Multidisciplinary collaboration and close monitoring are key to outcome optimization in the management of the condition.
References
Cho, S. J., Lee, J. Y., Jeong, Y., Cho, S. Y., Lee, D.-G., Choi, J. Y., & Park, H. J. (2023). Milnacipran has an antihyperalgesic effect on cisplatin-induced neuropathy. Pharmaceutics, 15(9), 2218. https://doi.org/10.3390/pharmaceutics15092218
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), 25532. https://doi.org/10.52965/001c.25532
Harden, R. N., McCabe, C. S., Goebel, A., Massey, M., Suvar, T., Grieve, S., & Bruehl, S. (2022). Complex regional pain syndrome: Practical diagnostic and treatment guidelines, 5th edition. Pain Medicine, 23(Supplement_1), S1–S53. https://doi.org/10.1093/pm/
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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.
Decision Tree for Neurological and Musculoskeletal Disorders
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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:
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.