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Decision Tree for Neurological and Musculoskeletal Disorders

Decision Tree for Neurological and Musculoskeletal Disorders

Decision Tree for Neurological and Musculoskeletal Disorders

This paper is an examination of a case study of a patient with neurological and musculoskeletal disorder. The essay summarizes the patient’s case study, treatment decisions, and assesses if evidence-based literature supports the decisions. It also explores the anticipated outcomes with the selected decisions and if there were differences in the outcomes.

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Summary of the Case Study

The case study is of a 43-year-old white male that presents to the office with complain of pain. He ambulates with the assistance of crutches. The patient came as a referral by his family doctor for psychiatric assessment since he believes that the client’s problem is in his head. The client reports a history of fall and numerous diagnostic tests. The client developed cramping of his right leg accompanied by color changing to purple from knee down. Mental status examination led to the client being diagnosed with complex regional pain disorder (reflex sympathetic dystrophy).

Treatment Decisions

The first decision made for the client is initiating him on Amitriptyline 25 mg po QHS and titrating upward weekly by 25 mg to a maximum dose of 200 mg per day. The second treatment decision for the client is continuing current medication and increase dose to 125 mg at bedtime this week continuing towards the goal 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. The third decision is to continue with the current dose of Elavil 125 mg per day, refer the client to a life coach who can counsel him on good dietary habits and exercise.

If the Decisions were Supported by Evidence-Based Literature

Evidence-based literature supports the above decisions. According to Komoly, (2019), amitriptyline is high effective in reducing pain, motor and autonomic symptoms that patients with regional pain syndrome experience. An investigation by Javed and Abdi (2021) revealed that amitriptyline demonstrated similar efficacy to gabapentin in managing complex regional pain syndrome. In another study, Vescio et al., (2020) found that the use of amitriptyline for complex regional pain syndrome was associated with improvements in functionality, pain symptoms, and sleep disturbances. Therefore, evidence-based literature supports the decision to treat the patient in the case study with amitriptyline.

What I was Hoping to Achieve with the Decisions

One of the things that I was hoping to achieve in the first decision was to reduce the pain the patient experiences and improve his functioning. Amitriptyline has been shown to improve neuropathic pain, autonomic and motor symptoms, sleep disturbances, and functionality in patients with complex regional pain syndrome (Javed& Abdi, 2021; Komoly, 2019). Amitriptyline is an antidepressant associated with side effects such as suicidal thoughts, attempts or ideations, QT prolongation, torsade de pointes, and sudden cardiac arrest leading to death. As a result, patients should be initiated on the lowest possible dosage and titrated upwards based on the patient’s response (Vescio et al., 2020).

I was hoping that the second decision would result in further improvement in pain and client’s functional abilities. An increase in the dosage of Amitriptylinewas expected to result in sustained improvement in symptoms, hence, functioning and quality of life. I also expected the client no to develop side and adverse effects associated with the drug. I anticipated sustained improvement in pain and functioning in the third decision(Shermon et al., 2023). The optimum therapeutic dose of amitriptyline would have been achieved, leading to minimum occurrence of symptoms of complex regional pain syndrome.

Differences

The outcome in decision one did not align with my expectations. The client returned the clinic with reports of mild reduction in pain and improvements in functioning. The desired serum therapeutic dose of amitriptyline had not been reached at this step. I did not expect the client to report weight gain with the increase in dosage in the second decision. However, weight gain is a common side effect with the use of antidepressants, hence, the need for referring the client to a counselor for education and guidance of healthy lifestyles and behaviors(Handa, 2021; Harnik et al., 2023).

Conclusion

The use of amitriptyline was effective in treating the patient in the case study. Evidence-based literature supports the use of amitriptyline for complex regional pain. I was hoping that the decisions made would result in pain reduction, improved functioning, and quality of life of the patient. There were minimal differences noted between the outcomes and my anticipations.

 

 

References

Handa, R. (2021). Complex Regional Pain Syndrome.In R. Handa (Ed.), Clinical Rheumatology (pp. 201–203).Springer. https://doi.org/10.1007/978-981-33-4885-1_25

Harnik, M. A., Kesselring, P., Ott, A., Urman, R. D., &Luedi, M. M. (2023).Complex Regional Pain Syndrome (CRPS) and the Value of Early Detection.Current Pain and Headache Reports. https://doi.org/10.1007/s11916-023-01124-3

Javed, S., & Abdi, S. (2021). Use of anticonvulsants and antidepressants for treatment of complex regional pain syndrome: A literature review. Pain Management, 11(2), 189–199. https://doi.org/10.2217/pmt-2020-0060

Komoly, S. (2019).[Treatment of complex regional pain syndrome with amitriptyline].Ideggyogyaszatiszemle, 72(7–8), 279–281. https://doi.org/10.18071/isz.72.0279

Shermon, S., Fazio, K. M., Shim, R., Abd-Elsayed, A., & Kim, C. H. (2023). Prescription Trends in Complex Regional Pain Syndrome: A Retrospective Case–Control Study. Brain Sciences, 13(7), Article 7. https://doi.org/10.3390/brainsci13071012

Vescio, A., Testa, G., Culmone, A., Sapienza, M., Valenti, F., Di Maria, F., &Pavone, V. (2020). Treatment of Complex Regional Pain Syndrome in Children and Adolescents: A Structured Literature Scoping Review. Children, 7(11), Article 11. https://doi.org/10.3390/children7110245

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Decision Tree for Neurological 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.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

  • Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
    • Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)
    • Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)
    • Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)
    • Chapter 14, “Muscarinic Antagonists” (pp. 90-98)
    • Chapter 15, “Adrenergic Agonists” (pp. 99–107)
    • Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
    • Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
    • Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
    • Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
    • Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
    • Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
    • Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
    • Chapter 24, “Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics” (pp. 183–194)
    • Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)
    • Chapter 60, “Drug Therapy of Gout” (pp. 528–536)
    • Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)
  • American Academy of Family Physicians. (2019). Dementia

Required Media

  • Links to an external site. [Interactive media file]. Baltimore, MD: Author.

    In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.

  • Links to an external site. [Interactive media file]. Baltimore, MD: Author.

    In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders.

Disorders of The Nervous System

  • Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)
  • Speed Pharmacology. (2019). Drugs for Parkinson’s Disease (Made Easy)

Links to an external site. [Video]. https://www.youtube.com/watch?v=euzRPrvrwj0&t=31s

Note: This media program is approximately 7 minutes.

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.

You will submit this Assignment in Week 8.

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