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1White Male With Hip PainHolly BowlingWalden UniversityNURS 6630: Psychopharmacologic Approaches to Treatment of PsychopathologyDr. Carman SilverJuly 20, 2020
2White Male With Hip PainComplex Regional Pain Disorder/Syndrome (CRPD/S) is a chronic condition that canaffect the peripheral and central nervous system and is characterized by pain lasting longer thansix months to an affected limb, usually after injury (National Institute of Neurological Disordersand Stroke (NINDS), 2019). CRPS is divided into two different categories, where CRPS-Iindicates an individual without a confirmed nerve injury, and CRPS-II indicated an individualwith an associated or confirmed nerve injury in the affected area (Brinker’s, Rumpelt, Lux,Kretzschmar, & Pfau, 2018). Specific manifestations CRPD may include abnormal movementsof the affected limb, incoordination, hair, and nail growth pattern changes, burning andsqueezing nerve pain, skin texture changes, changes in skin color such as erythema orecchymosis, heat or coldness to the affected area, as well as swelling (NINDS, 2019). CRPD canaffect anyone of any age, even though it is typically more common in middle-aged women(NINDS, 2019). The following discussion will focus on a treatment plan for a 43-year-old whitemale with hip pain that was recently diagnosed with complex regional pain disorder (CRPD).The best treatment option will be based on three decision trees and overall pharmacodynamicsand pharmacokinetics that are best appropriate for the client scenario provided.Decision 1The first decision point I chose for this patient was to start Amitriptyline 25 mg PO QHSand titrate upward weekly by 25 mg to a max dose of 200 mg per day. The reason I choseAmitriptyline is that it is a tricyclic antidepressant that is commonly used as an agent to helprelieve nerve pain as well (Rosenthal & Burchum, 2018). The client discussed how heoccasionally uses hydrocodone, but does not really like to due to the way it makes him feel, andsince Amitriptyline has an analgesic effect that may help enhance the effects of opioids, the
3client may be able to reduce his dosage even more, or even quit using altogether depending onthe results of the Amitriptyline (Rosenthal & Burchum, 2018). The client has been living withchronic pain for over seven years, he lost his job, and his fiancé left him, however, he deniesdepression. He does admit to getting “down in the dumps” sometimes, and with his currentsituation, he certainly is a risk for depression. Multiple drugs are currently being used to helptreat CRPD, such as antidepressants, calcium channel blockers, non-steroidal anti-inflammatorydrugs (NSAID’s), muscle relaxants, analgesics, and anticonvulsants, with bisphosphonates beingthe most widely studied agent to treat CRPD (Resmini, Ratti, Canton, Murena, Moretti, &Iolascon, 2015). There is not currently any drug or combinations of drugs that are proven orguaranteed to be effective in each person, nor is there any specific drug approved by the FDA in