Decision Tree for Neurological and Musculoskeletal Disorders Essay

Decision Tree for Neurological and Musculoskeletal Disorders Essay

Decision Tree for Neurological and Musculoskeletal Disorders Essay

The case study is about a 43-year-old male referred for psychiatric assessment by his PCP due to chronic pain that has lasted seven years. He reports having occasional low moods but denies depression. He uses low doses of Hydrocone since it causes drowsiness and constipation, although it does not relieve pain effectively. His primary diagnosis is Complex regional pain disorder. The purpose of this paper is to discuss the decisions selected for each treatment decision, what I was hoping to achieve, and compare the expected and actual results.

Decision One

In decision one, the patient was prescribed Amitriptyline 25 mg PO QHS, which was increased weekly by 25 mg. Amitriptyline is an SNRI indicated for managing depression, central pain, and posttraumatic neuropathy. The decision is supported by evidence-based literature because Amitriptyline is considered a successful evidence-based treatment for peripheral diabetic neuropathic pain and other neuropathic pain disorders (Shim et al., 2019). According to Komoly (2019), it effectively alleviates pain and autonomic and motor symptoms in the chronic regional pain syndrome. I hoped that Amitriptyline would improve his mood and alleviate the patient’s pain to a severity of 5/10 to stop using crutches. The actual and expected outcomes were almost similar since, after four weeks, the patient’ s pain had improved to 6/10, and he did not use crutches, but he wished for lesser pain intensity.

Decision Two

In decision two, the current medication was continued, but the dose increased to 125 QHS continuing towards the target dose of 200 mg daily. The patient was instructed to take medication an hour earlier than normal. The decision is supported by evidence-based literature, which recommends that the Amitriptyline dose be gradually increased if a positive response is demonstrated. Eldufani et al. (2020) explain that increasing the Amitriptyline bedtime dose taking the drug an hour earlier reduces morning sleepiness. The expected outcome was to alleviate pain to a severity of 3/10 and decrease morning sleepiness. The expected and actual outcomes were almost similar as the patient reported improved pain relief with a severity of 4/10 and decreased morning sleepiness. Nevertheless, he complained of weight gain, a common side effect of Amitriptyline (Komoly, 2019).

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Decision Three

In decision three, the patient was continued on the current dose of Amitriptyline at 125 mg per day. He was also referred to a life coach for counseling on healthy dietary habits and exercise. The decision is also backed by evidence-based literature. Eldufani et al. (2020) explain that weight gain is a common side effect of Amitriptyline. Therefore, patients on Amitriptyline should be counseled on lifestyle modification to healthy dietary practices and regular physical exercises to manage weight and prevent overweight (Thour & Marwaha, 2022). The clinician expected that referring the client to a life coach would help the client adopt healthy dietary habits and physical exercise patterns and thus maintain a healthy weight.

Conclusion

The patient was initiated on Amitriptyline 25 mg PO QHS and increased weekly by 25 mg to a maximum of 200 mg OD. Amitriptyline was continued in the second decision, but the dose increased to 125 mg QHS. However, the treatment was associated with weight gain, which led to referring the patient for counseling on good dietary habits and exercise.

References

Eldufani, J., Elahmer, N., & Blaise, G. (2020). A medical mystery of complex regional pain syndrome. Heliyon, 6(2), e03329. https://doi.org/10.1016/j.heliyon.2020.e03329

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

Shim, H., Rose, J., Halle, S., & Shekane, P. (2019). Complex regional pain syndrome: a narrative review for the practising clinician. British journal of anaesthesia, 123(2), e424–e433. https://doi.org/10.1016/j.bja.2019.03.030

Thour, A., & Marwaha, R. (2022). Amitriptyline. In StatPearls. StatPearls Publishing.

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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.

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.