Introduction
A 43-year-old male with a 4-year history of various symptoms is diagnosed with complex regional pain syndrome (CRPS). CRPS is a neuropathic disorder characterized by chronic pain that commonly occurs after an injury and usually affects only one limb of the body. Although medical experts are not entirely certain what causes CRPS, more than 90 percent of cases involve a history of trauma or injury (Caffrey, 2019). In the course of treatment, the patient was prescribed several medications, which caused a reduction of pain together with insignificant side effects.
Analysis of Decision 1
At his first visit, the patient was prescribed amitriptyline 25 mg PO QHS and titrated upward by 25 mg each week to a maximum dose of 200 mg daily. Amitriptyline is a tricyclic antidepressant that is primarily used to treat depression and various pain syndromes, including neuropathic pain. It interferes with the chemical processes in the brain, increasing the neurotransmission of serotonin. Along with other tricyclic antidepressants, it is confirmed to be efficient in treating various neuropathic pain conditions and is recommended first-line (Moore et al., 2015). Its side effects primarily include cardiovascular problems, such as hypotension, syncope, hypertension, and tachycardia, and CNS symptoms, such as seizures, tremors, EOPS, drowsiness, fatigue, and headache (Sandoz, 2014). Other potential side effects are anticholinergic symptoms, such as hyperpyrexia, urinary retention, constipation, and dry mouth, skin rash, and gastrointestinal problems, such as nausea, vomiting, and anorexia (Sandoz, 2014). Overall, amitriptyline is an effective medication that is often prescribed in such cases.
After four weeks, the patient reported an improvement in pain and function and the side effect of being “groggy” in the morning. According to the study by Mago et al. (2018), 50 % of patients treated with antidepressants verbalized feelings of frustration or dissatisfaction with health care because of lack of efficacy and side effects. That is why it was important to address the patient’s concerns regarding his grogginess and need for additional pain control.
Analysis of Decision 2
At the patient’s second visit, it was decided to continue the current medication while taking the dose of 125 mg at bedtime and steadily increase it until the goal dose of 200 mg daily is achieved. The patient was asked to call the hospital in 3 days to tell them about his condition in the morning. It allowed the physician to evaluate the response to treatment without having to wait for the four-week checkup.
At the checkup, the patient reported improved pain control up to 4 out of 10 and feeling less groggy in the morning. His “episodic” cramping has decreased twice in the past month, and his mobility has improved to him being able to move around the apartment without crutches. However, the patient reported concerns about his slight weight gain since the start of the medication.
Analysis of Decision 3
At the third visit, the patient was advised to continue the current dose of amitriptyline of 125 mg per day and refer to a specialist who can consult him on eating habits and exercise. According to the research by Annesi (2020), “exercise-induced mood improvements foster greater self-regulation and reduced emotional eating” (p. 1). Physiotherapy and occupational therapy play an important role in the interdisciplinary treatment and rehabilitation of CRPS (Villa et al., 2016). The patient’s prognosis is positive, with his weight gain being an issue that can be easily addressed with the help of a specialist.
Conclusion
CRPS includes a complex array of symptoms and requires a multidisciplinary approach to treatment. With the pain being improved with medication, the patient began to heal holistically. The further treatment strategy needs to address the current concerns and reduce side effects, including weight gain. The treatment plan needs to include follow-up visits, medication management, compliance with schedule, evaluation of side effects, and additional treatment options. They can include dietary, exercise, and behavioral counseling, relaxation and mindfulness practice, and participation in support groups for people suffering from CRPS.
References
Annesi, J. (2020). Sequential changes advancing from exercise-induced psychological improvements to controlled eating and sustained weight loss: A treatment-focused causal chain model. The Permanente Journal, 24, 19.235. Web.
Caffrey, C. (2019). Complex regional pain syndrome (CRPS). In Salem Press Encyclopedia of Health. Salem Press.
Mago, R., Fagiolini, A., Weiller, E., & Weiss, C. (2018). Healthcare professionals’ perceptions on the emotional impact of having an inadequate response to antidepressant medications: Survey and prospective patient audit. Annals of General Psychiatry, 17.
Moore, R., Derry, S., Aldington, D., Cole, P., & Wiffen, P. J. (2015). Amitriptyline for neuropathic pain in adults. Cochrane Database of Systematic Reviews, 7. Web.
Sandoz (2014). Amitriptyline. Federal Drug Administration.
Villa, M., Rittig-Rasmussen, B., Mikkelsen, L., & Poulsen, A. (2016). Complex regional pain syndrome. Manual Therapy, 26, 223–230. Web.