RESULTS OF DECISION POINT ONE
RESULTS OF DECISION POINT TWO
Guidance to Student
At this point, the client is almost at his goal pain control and increased functionality. Weight gain is a common side effect with amitriptyline and should be a counseling point at the initiation of therapy. He has a small weight gain of 5 pounds in 8 weeks. A reduction in dose may have an effect on the weight gain but at a considerable cost of pain to the client. This would not be in the best interest of the client at this point. Amitriptyline has a side effect of cardiac arrhythmias. He is not experiencing this at this point. The drug, qsymia contains a product called phentermine which has a history of causing cardiac arrhythmias at higher doses. This product is also only approved for a client with obesity defined as a BMI greater than 30 kg/m2. Your client’s BMI is currently 25.5 kg/m2. He does not meet the definition of obesity but is considered overweight. His best course of action would be to continue the same dose of Elavil, counsel him on good dietary and exercise habits and connect him with a life coach who will help him with this problem in a more meaningful way than a 10 minute counseling session will be able to accomplish.
Guidance to Student
At this point, the client is almost at his goal pain control and increased functionality. Weight gain is a common side effect with amitriptyline and should be a counseling point at the initiation of therapy. He has a small weight gain of 5 pounds in 8 weeks. A reduction in dose may have an effect on the weight gain but at a considerable cost of pain to the client. This would not be in the best interest of the client at this point. Amitriptyline has a side effect of cardiac arrhythmias. He is not experiencing this at this point. The drug, qsymia contains a product called phentermine which has a history of causing cardiac arrhythmias at higher doses. This product is also only approved for a client with obesity defined as a BMI greater than 30 kg/m2. Your client’s BMI is currently 25.5 kg/m2. He does not meet the definition of obesity but is considered overweight. His best course of action would be to continue the same dose of Elavil, counsel him on good dietary and exercise habits and connect him with a life coach who will help him with this problem in a more meaningful way than a 10 minute counseling session will be able to accomplish.
Guidance to Student
At this point, the client is almost at his goal pain control and increased functionality. Weight gain is a common side effect with amitriptyline and should be a counseling point at the initiation of therapy. He has a small weight gain of 5 pounds in 8 weeks. A reduction in dose may have an effect on the weight gain but at a considerable cost of pain to the client. This would not be in the best interest of the client at this point. Amitriptyline has a side effect of cardiac arrhythmias. He is not experiencing this at this point. The drug, qsymia contains a product called phentermine which has a history of causing cardiac arrhythmias at higher doses. This product is also only approved for a client with obesity defined as a BMI greater than 30 kg/m2. Your client’s BMI is currently 25.5 kg/m2. He does not meet the definition of obesity but is considered overweight. His best course of action would be to continue the same dose of Elavil, counsel him on good dietary and exercise habits and connect him with a life coach who will help him with this problem in a more meaningful way than a 10 minute counseling session will be able to accomplish.
RESULTS OF DECISION POINT TWO
Guidance to Student
At this stage of therapy, anyone of the above mentioned options could be appropriate therapy except for the addition of oxycodone. Opioid analgesics rarely will help with neuropathic-type pain which is what our client is experiencing. As the client continues with the oxycodone, it will continue to be in-effective. The in-effectiveness of opioids on neuropathic pain leads to dose escalation. Soon, the client is escalating the dose on his own and you risk induction of an addictive disorder in the client that will require treatment. BioFreeze is an interesting product. It is menthol. I have copied the mechanism of action from their website:
1. Menthol Counter-irritant Effect: The counter-irritant theory suggests that menthol stimulates cutaneous sensory receptors. This blocks pain signals from reaching the brain via the “Gate Control” theory (Melzak & Wall 1965).
2. Cryotherapy through Evaporation: Evaporation of alcohol and menthol reduce skin temperature, which stimulates thermosensitive cold receptors in the skin known as “TRP-M8” receptors. These specific receptors have been shown to play a role in pain control through the body’s glutamate (Proudfoot et al. 2006) or opioid system (Galaeotti et al. 2002).
This is a great topical product that can offer immediate relief from pain and does not have addictive properties. It should, however, not be relied on for the sole purpose of extended pain relief as the menthol lasts for about 2 hours and then requires re-application. Lidocaine patches are another option for a topical analgesia but is long acting. Remember, lidocaine, in higher doses can also cause cardiac dysrhythmias and should be limited to no more than (3) patches applied at one time. Although it is a topical product, about 3% of lidocaine becomes available systemically due to absorption. Lidocaine in continuous use results in a tolerance to the effects of the medication and, therefore, requires a 12 hour drug free period.
Guidance to Student
At this stage of therapy, anyone of the above mentioned options could be appropriate therapy except for the addition of oxycodone. Opioid analgesics rarely will help with neuropathic-type pain which is what our client is experiencing. As the client continues with the oxycodone, it will continue to be in-effective. The in-effectiveness of opioids on neuropathic pain leads to dose escalation. Soon, the client is escalating the dose on his own and you risk induction of an addictive disorder in the client that will require treatment. BioFreeze is an interesting product. It is menthol. I have copied the mechanism of action from their website:
1. Menthol Counter-irritant Effect: The counter-irritant theory suggests that menthol stimulates cutaneous sensory receptors. This blocks pain signals from reaching the brain via the “Gate Control” theory (Melzak & Wall 1965).
2. Cryotherapy through Evaporation: Evaporation of alcohol and menthol reduce skin temperature, which stimulates thermosensitive cold receptors in the skin known as “TRP-M8” receptors. These specific receptors have been shown to play a role in pain control through the body’s glutamate (Proudfoot et al. 2006) or opioid system (Galaeotti et al. 2002).
This is a great topical product that can offer immediate relief from pain and does not have addictive properties. It should, however, not be relied on for the sole purpose of extended pain relief as the menthol lasts for about 2 hours and then requires re-application. Lidocaine patches are another option for a topical analgesia but is long acting. Remember, lidocaine, in higher doses can also cause cardiac dysrhythmias and should be limited to no more than (3) patches applied at one time. Although it is a topical product, about 3% of lidocaine becomes available systemically due to absorption. Lidocaine in continuous use results in a tolerance to the effects of the medication and, therefore, requires a 12 hour drug free period.
Guidance to Student
At this stage of therapy, anyone of the above mentioned options could be appropriate therapy except for the addition of oxycodone. Opioid analgesics rarely will help with neuropathic-type pain which is what our client is experiencing. As the client continues with the oxycodone, it will continue to be in-effective. The in-effectiveness of opioids on neuropathic pain leads to dose escalation. Soon, the client is escalating the dose on his own and you risk induction of an addictive disorder in the client that will require treatment. BioFreeze is an interesting product. It is menthol. I have copied the mechanism of action from their website:
1. Menthol Counter-irritant Effect: The counter-irritant theory suggests that menthol stimulates cutaneous sensory receptors. This blocks pain signals from reaching the brain via the “Gate Control” theory (Melzak & Wall 1965).
2. Cryotherapy through Evaporation: Evaporation of alcohol and menthol reduce skin temperature, which stimulates thermosensitive cold receptors in the skin known as “TRP-M8” receptors. These specific receptors have been shown to play a role in pain control through the body’s glutamate (Proudfoot et al. 2006) or opioid system (Galaeotti et al. 2002).
This is a great topical product that can offer immediate relief from pain and does not have addictive properties. It should, however, not be relied on for the sole purpose of extended pain relief as the menthol lasts for about 2 hours and then requires re-application. Lidocaine patches are another option for a topical analgesia but is long acting. Remember, lidocaine, in higher doses can also cause cardiac dysrhythmias and should be limited to no more than (3) patches applied at one time. Although it is a topical product, about 3% of lidocaine becomes available systemically due to absorption. Lidocaine in continuous use results in a tolerance to the effects of the medication and, therefore, requires a 12 hour drug free period.
RESULTS OF DECISION POINT TWO
Guidance to Student
Clients in pain want immediate help. Sometimes they get lost in the syndrome and forget that you are trying to help and will blame you for any back steps. Don’t take it personal. It is not the client taking but rather the disease state taking its’ toll on their ability to think rationally. A dose increase with the Neurontin will only worsen the daytime drowsiness, especially if he was only taking it at bedtime and will now take it throughout the day. Referring clients who have pain syndromes to a clinic that specializes in pain is never a bad option and sometimes is the best option. If you do make this referral, then you will need to bridge therapy until the clinic is able to see the client. The amitriptyline seemed to work. Continuing with this medication is a good option. Early morning drowsiness of grogginess can usually be alleviated with a change in administration time. An hour or two earlier usually will give the results you are looking for and should be tried first before a medication change.
Guidance to Student
Clients in pain want immediate help. Sometimes they get lost in the syndrome and forget that you are trying to help and will blame you for any back steps. Don’t take it personal. It is not the client taking but rather the disease state taking its’ toll on their ability to think rationally. A dose increase with the Neurontin will only worsen the daytime drowsiness, especially if he was only taking it at bedtime and will now take it throughout the day. Referring clients who have pain syndromes to a clinic that specializes in pain is never a bad option and sometimes is the best option. If you do make this referral, then you will need to bridge therapy until the clinic is able to see the client. The amitriptyline seemed to work. Continuing with this medication is a good option. Early morning drowsiness of grogginess can usually be alleviated with a change in administration time. An hour or two earlier usually will give the results you are looking for and should be tried first before a medication change.
Guidance to Student
Clients in pain want immediate help. Sometimes they get lost in the syndrome and forget that you are trying to help and will blame you for any back steps. Don’t take it personal. It is not the client taking but rather the disease state taking its’ toll on their ability to think rationally. A dose increase with the Neurontin will only worsen the daytime drowsiness, especially if he was only taking it at bedtime and will now take it throughout the day. Referring clients who have pain syndromes to a clinic that specializes in pain is never a bad option and sometimes is the best option. If you do make this referral, then you will need to bridge therapy until the clinic is able to see the client. The amitriptyline seemed to work. Continuing with this medication is a good option. Early morning drowsiness of grogginess can usually be alleviated with a change in administration time. An hour or two earlier usually will give the results you are looking for and should be tried first before a medication change.