Decision Tree for Neurological and Musculoskeletal Disorders Essay Paper
Decision Tree for Neurological and Musculoskeletal Disorders Essay Paper
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 re
gional 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.