Chronic Pain Analysis - Case Study Sample

Introduction

Ms. Brown did a commendable job in her case study about chronic pain. I feel that the case study is beneficial in creating awareness on how to handle patients suffering from chronic diseases and its containment measures. I am glad that Ms. Brown followed the necessary steps towards the treatment of CJ by doing a detailed assessment before going on with the treatment. However, I feel that CJ has been under the misuse of opioid drugs from the beginning due to the persistent side effects such as anxiety, nerve ablation, and lack of sleep at nights accompanied by pains. According to Sadock et al. (2015), it would be appropriate to begin with, nonpharmacologic treatments such as physical exercises alongside home medications to attain the target responses in the long run.

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Increasing Dosage

I agree with Ms. Brown's idea of increasing CJ’s initial oral dosage of Oxycodone medicine from 5mg/day to 15mg/every 4-6 hours to induce pain. However, I feel that the combination of Oxycodone with antidepressants will cause severe damage to the brain, especially if CJ is under somebody’s watch at home. The use of antidepressants may hinder the activity of Oxycodone drugs when administered together. Oxycodone drugs cause severe pain and even death to patients when they are not under a physician (American Psychiatric Association, 2013). Also, I am glad that CJ does demonstrate compliance with the increase of Oxycodone and MS Contin drugs by exhibiting a positive outcome.

The docusate medicine that CJ is currently using does no compliance with him because it requires more time to give the desired results. I feel that Ms. Brown included docusate medicine for trial in this case since it only serves to control constipation. In this case, pharmacological and non-pharmacological therapy, including polyethylene glycol, psyllium, or lactose, will provide appropriate evidence for constipation (BE, 2019). The minimal interactions of CJ, accompanied by possible adverse effects, serves as proof that docusate is not suitable for constipation. An increase in the docusate initial dose from 100mg to 300mg/day was only crucial for bowel improvement and not to control constipation.

Neuro Examination

Ms. Brown's idea to incorporate full PE with neuro examination, questionnaires, interviews, and discussions in her treatment plan about CJ was appropriate. The questionnaires will help obtain more information about CJs' characteristics by showing how long he has been suffering from the disease, diagnostic purposes, and behaviors. Her idea will allow her to get more information about the previous diagnosis and treatment processes. Also, recommendations on the follow-ups will assist Ms. Brown to know whether the treatment process of CJ is going in the right direction or not as expected.

Ms. Brown is consistent and concerned with the well-being of CJ. I like how she incorporated short term and long term goals both in the office and at home in her plan of care. The long term goals for CJ in the office is appropriate; however, I feel that she should include a specific time for engagements with CJ due to other office work processes which might be taking place. Physical therapy, discussions, education on non-pharmacological education, among other long-term goals, shows that Ms. Brown is much committed to providing better healthcare. The referrals to NCV, CBT, and physical therapy will help determine the current medication and including the next medication process.

Short and long-term therapeutic goals at home will assist Ms. Brown to know CJ's physical and social treatment progress. I agree that physical exercise is one of the main physical activities required for body activation. Therefore, I would advise CJ to do exercises from three to four times daily to enhance his body and physical fitness.

Holistic Approach

I am glad that Ms. Brown’s included yoga, herbal therapy alongside a holistic approach in her case study plan. Yoga therapy is essential in strengthening muscles and maintaining body stability, reducing anxiety, and improving the sleeping habits of CJ (Leitner et at., 2016). Herbal therapy can also accelerate positive health changes through a holistic approach with nutritional supplements, minerals, and multivitamins. Treatment at home and in the office will help Ms. Brown examine CJ and know what medication to embark on in the next treatment phase.

I understand the need to consider new medication on CJ. Pharmacological therapy, which includes both new and current medications, will work better for chronic pain. She can recommend using Duloxetine (Cymbalta) drugs for anxiety, depression, and nerve pains for CJ treatment. I agree with Ms. Browns' new recommendation of 30mg/dose every day. However, I would start with 60mg per day of duloxetine drug due to CJ’s ongoing chronic pain. I am glad that Ms. Brown limited the use of antidepressant medications in her case study. Antidepressants can cause severe pain and damage to CJ, including conflicting results (American Psychiatric Association, 2013). These drugs always interfere with the activity and reaction of some drugs when combined.

Conclusion

Hospitals recommend the use of Diclofenac medicine to treat allergies and induce pain to patients (BE, 2019). I feel that the parameters and methods on Ms. Browns' medication will guide CJ to be aware of the medicines side effects. I agree with the use of Diclofenac Transdermal patch on the most painful area is appropriate to maintain long term pain relief and to protect CJ from allergic reactions. On the same note, Tramadol is more powerful for treatment than diclofenac and it can function in the absence of diclofenac effectively. I feel that Ms. Brown would recommend tramadol drug for treatment and omit diclofenac. Finally, I am happy with the in-depth new medication description of Ms. Brown on CJs’ condition.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

BE, W. (2019). Things we do for no reason: prescribing docusate for constipation in hospitalized adults. Journal of hospital medicine, 14(2), 111.
https://cdn.mdedge.com/files/s3fs-public/issues/articles/jhm014020110.pdf

Leitner, G. C., & Vogelsang, H. (2016). Pharmacological-and non-pharmacological therapeutic approaches in inflammatory bowel disease in adults. World journal of gastrointestinal pharmacology and therapeutics, 7(1), 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734954/

Sadock, BJ, Sadock, V.A., Ruiz., P (2015). Kaplan and Sadock synopsis of psychiatry (11th ed.). Baltimore, MD: Williams & Wilkins.