This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical interview, the client reports that his family doctor sent him for psychiatric assessment because the doctor felt that the pain was “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.”
The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 o’clock to 12 o’clock position). He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said “there is no such thing as RSD, it comes from depression” and this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states “I said ‘no,’ there is no need for a wheelchair, I can beat this!”
Assessing and Treating Clients with Pain
The issue of complex regional pain syndrome is a health condition and affects the legs and hands of the patient and may end up leading to the impairment of the psychosocial functioning of the patient. The patient is 43 years old and has been presented to the clinic with the complaint of pain and is using crutches in his movement. The client indicates that the family physician had the view that the condition is all in his head. He indicates that the physician is of the view that he is making staff up and that it was not true that he was having pain. This paper helps in the assessment of the patient medication and the expected results for use of the medication.
Decision Point One
Decision point one is the use of Amitriptyline 25 mg PO QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day. The selection of the use of Amitriptyline is attributed to the fact that the medication is mainly intended to help in treating pain and helps in the prevention of issues of nerve and back pain (Dean, 2017). The medication as per Urquhart et al. (2018) works in two chemicals the noradrenaline and serotonin in the nerves. The medication helps in lowering the pain signal. The medication as well is instrumental in that it helps in the reduction of the level of pain.
The expected outcome is for the patient to come back in 4 weeks and indicate that the issue of pain has reduced and that he should not be using crutches anymore. The expected level of pain that the patient is expected to report after 4 weeks of use of Amitriptyline is 3 out of 10. The results of the decision after four weeks is that the patient comes back still using crutches and points out that the pain has improved. He points out that the pain level of 6 out of 10. He can do some chores like going to the bathroom….
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