Side Effects and Pain

HIP PAIN

A Caucasian Man with Hip Pain

Decision Point One

The patient presents physical, social, and psychological complications. He is experiencing pain in his hip but is considered to be an unsuitable candidate for a hip replacement because of his age. The initial diagnosis was torn cartilage but the patient has also been diagnosed with complex regional pain syndrome (CRPS). He previously worked as a machinist but has since been unemployed and has a conflicted relationship with his girlfriend who has accused him of being a junky. The patient does exhibit some symptoms of depression.

The patient has previously complained about the negative side effects of some of the drugs he has been given to address his pain symptoms, including constipation and sleepiness. Given this, the use of the tricyclic antidepressants like amitriptyline would seem counterproductive given that these drugs often produce similar side effects ("Amitriptyline," 2016). However, Savella is a drug designed to simultaneously treat chronic pain and depressive symptoms, even though it is not classified as an antidepressant. It is often used to treat fibromyalgia and other diseases that have complex etiologies and which involve multiple psychological and physical symptoms. "Savella is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). It is similar to drugs used to treat depression and other psychiatric disorders" ("Savella," 2017).

The drug's mechanism of operation is based upon the idea that people who suffer from chronic pain often develop a lower threshold for that pain after a certain point, and the effects of the drug are designed to bring about a more normal response. However, like other antidepressants, side effects are still a concern. There is also a risk of drowsiness and constipation with Savella, although the likelihood of manifesting these symptoms is considered only mild-to-moderate. Still, the specific symptoms Savella is designed to treat and the fact that it is recommended for depression associated with pain and a combination of physical and psychological problems makes it a better fit for the patient and will hopefully alleviate both his symptoms of physical discomfort and depression.

Decision Point Two

Given that the patient is still experiencing an unacceptable level of discomfort and pain, further treatment is warranted. The patient was treated with Elavil (Amitriptyline) but is still experiencing pain. This suggests that treating the patient's psychological symptoms in isolation without treating his physical symptoms is ineffective. The patient is also dissatisfied with the side effects of the drug. Reducing the dosage to mitigate the side effects but not discontinuing the drug altogether would be wise, given total cessation of an antidepressant without slowly weaning the patient from the drug could be psychologically devastating.

A non-drug-based treatment for the patient's pain would be advised, given that treating patients with chronic pain with opiate-based treatments runs the risk of drug dependence as well as producing further drowsiness, constipation, and other unpleasant side effects. Biofreeze roll-on therapy is a topical analgesic. It is advertised as providing the benefits of icing without the discomfort and inconvenience of cold treatment. Although intensive cold therapy is offered at various treatment centers, Biofreeze allows for regular application on a daily basis. Given the patient's lack of mobility, the treatment seems to be an effective compromise solution. According to Biofreeze's advertised benefits on the treatment's website: "'Cold therapy,' cryotherapy is the application of cold to temporarily relieve pain. The most common form of cryotherapy is ice. Biofreeze Professional produces the same sensation of cold that accompanies icing but without the pain and numbness sometimes associated with ice. Best of all, Biofreeze products allow you to remain active during treatment" ("FAQs," 2016). The use of Biofreeze will also hopefully encourage the patient to engage in stimulation and massage of the affected areas on a regular basis. The diffuse nature of the patient's pain will allow him to administer the treatment as needed. Although not all patients respond equally well to Biofreeze, the relative lack of side effects (in contrast to other medications) suggests that it can be beneficial and at worst will result in no additional harm.

Decision Point Three