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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...
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…
References
Amitriptyline. (2016). Mayo Clinic. Retrieved from:
http://www.mayoclinic.org/drugs-supplements/amitriptyline-oral-route/side-effects/drg-20072061
FAQs. (2017). Biofreeze. Retrieved from: http://www.biofreeze.com/faqs
Lidocaine. (2017). Mayo Clinic. Retrieved from:
http://www.mayoclinic.org/drugs-supplements/lidocaine-topical-application-route/description/drg-20072776
http://www.webmd.com/fibromyalgia/guide/savella-for-fibromyalgia-treatment#1
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