Treatment Guidelines For Complex Regional Pain Syndrome
The paper will describe treatment recommendations for a 43-year-old white male diagnosed with Complex Regional Pain Syndrome (CRPS). The paper will have three different decision points, and at each decision point, the psychiatric mental health nurse practitioner (PMHNP) will have to choose one of the treatment options available and explain the rationale of each choice that was preferred. The paper will describe why starting with Amitriptyline is a better option than Savella or Neurontin. Next, the paper will explain why the PMHNP chose to continue therapy with Amitriptyline and continue towards reaching the daily dose of 200 mg per day instead of reducing the dose or adding other medications …show more content…
The patient was recently diagnosed with CRPS. The first treatment option provided for decision point one was to start drug therapy with Savella 12.5 mg by mouth once per day. The second treatment option presented was to increase to 12.5 mg twice per day for day 2 and day 3, then increased to 25mg twice per day for days 4-7. The third treatment option provided was to increase to 50 mg twice per day after that. The second option presented for decision point one was to start therapy with Amitriptyline 25mg by mouth at bedtime and increase the dose every week until max dose of 200 mg daily is reached. The third option given for decision point one was to start therapy with Neurontin 300mg by mouth at bedtime and increase every week until a max dose of 2400mg is reach (if needed). According to Gay, Béréni, and Legré (2013), only one study has evaluated the effectiveness in treating CRPS (type 1) with Neurontin, and the study showed that the patients just had moderate pain relief. On the other hand, antidepressants have shown to be effective against neuropathy pain; a study shows that patients taking antidepressants for neuropathy pain had approximately 50% of pain reduction (Gay, Béréni, & Legré, 2013). Furthermore, Katsuyama et al. (2014) explained that tricyclic antidepressants (TCAs) are considered first-line therapy for neuropathic pain. Therefore, for the decision …show more content…
The first option for decision point two is to continue current dose of Amitriptyline but increase bedtime dose to 125mg, take the medication one hour earlier, and continue towards the goal of 200 mg per day. The second option for decision point two is to reduce Amitriptyline to 75 mg at bedtime and add Biofreeze roll (for muscle cramping). The third option for decision point two is to lower the dose of Amitriptyline to 75 mg at night, add Neurontin 300mg by mouth at night, and place a follow-up appointment in 1 week. According to Stahl (2017), common side effects of Amitriptyline are sedation, and weight gain and the provider should wait before lowering the dose or switching to another drug. Also, Stahl (2017) explained that the largest dose of Amitriptyline should be given at bedtime due to its sedative properties. Therefore, for decision point two, the PMHNP will administer the largest dose at night and take the medication one hour earlier. The PMHNP hopes to resolve the groggy feeling in the mornings and continue to see an improvement in the patient’s pain level. The results for decision point two show that the patient’s pain level is were improved to 4 out of 10 but is now reporting an increase of 5 pounds in eight
The paper will describe treatment recommendations for a 43-year-old white male diagnosed with Complex Regional Pain Syndrome (CRPS). The paper will have three different decision points, and at each decision point, the psychiatric mental health nurse practitioner (PMHNP) will have to choose one of the treatment options available and explain the rationale of each choice that was preferred. The paper will describe why starting with Amitriptyline is a better option than Savella or Neurontin. Next, the paper will explain why the PMHNP chose to continue therapy with Amitriptyline and continue towards reaching the daily dose of 200 mg per day instead of reducing the dose or adding other medications …show more content…
The patient was recently diagnosed with CRPS. The first treatment option provided for decision point one was to start drug therapy with Savella 12.5 mg by mouth once per day. The second treatment option presented was to increase to 12.5 mg twice per day for day 2 and day 3, then increased to 25mg twice per day for days 4-7. The third treatment option provided was to increase to 50 mg twice per day after that. The second option presented for decision point one was to start therapy with Amitriptyline 25mg by mouth at bedtime and increase the dose every week until max dose of 200 mg daily is reached. The third option given for decision point one was to start therapy with Neurontin 300mg by mouth at bedtime and increase every week until a max dose of 2400mg is reach (if needed). According to Gay, Béréni, and Legré (2013), only one study has evaluated the effectiveness in treating CRPS (type 1) with Neurontin, and the study showed that the patients just had moderate pain relief. On the other hand, antidepressants have shown to be effective against neuropathy pain; a study shows that patients taking antidepressants for neuropathy pain had approximately 50% of pain reduction (Gay, Béréni, & Legré, 2013). Furthermore, Katsuyama et al. (2014) explained that tricyclic antidepressants (TCAs) are considered first-line therapy for neuropathic pain. Therefore, for the decision …show more content…
The first option for decision point two is to continue current dose of Amitriptyline but increase bedtime dose to 125mg, take the medication one hour earlier, and continue towards the goal of 200 mg per day. The second option for decision point two is to reduce Amitriptyline to 75 mg at bedtime and add Biofreeze roll (for muscle cramping). The third option for decision point two is to lower the dose of Amitriptyline to 75 mg at night, add Neurontin 300mg by mouth at night, and place a follow-up appointment in 1 week. According to Stahl (2017), common side effects of Amitriptyline are sedation, and weight gain and the provider should wait before lowering the dose or switching to another drug. Also, Stahl (2017) explained that the largest dose of Amitriptyline should be given at bedtime due to its sedative properties. Therefore, for decision point two, the PMHNP will administer the largest dose at night and take the medication one hour earlier. The PMHNP hopes to resolve the groggy feeling in the mornings and continue to see an improvement in the patient’s pain level. The results for decision point two show that the patient’s pain level is were improved to 4 out of 10 but is now reporting an increase of 5 pounds in eight