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Ssi Joint Pain Case Studies

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On admission, Ms. Pilkey subjectively described her pain as being rather excruciating. There were times when she had to curl up into a ball due to pain during the week prior to admission. Her headaches felt like a “stabbing pick which penetrates her head” that is not localized to a particular region. The initiation of topiramate on July 31st 2015 has helped. The frequency, duration and degree of pain from chronic daily headaches had reduced considerably, allowing Heather to have a better quality of life. However, the degree of cognitive impairment, manifested in difficulty understanding commands and word finding have been more pronounced. In addition, she often forgot to take her morning dose of topiramate due to the cognitive deficits…show more content…
SI joint pain has been an ongoing issue since the first accident, which she described as permeating into the hip and down her legs as an “aching, stabbing pain.” Moreover, this pain would produce the sensation of “warm water” running down the back of her leg. Her sleep is disturbed by her SI joint pain, neck pain or right shoulder pain. All of these combined make maintaining sleep difficult. The average length of sleep per night is 3-4 hours, and she has to nap early in the morning 2-2.5…show more content…
Although she finds it mildly beneficial, she complained of intense gastric pain while taking ibuprofen. Heather is wary of supplementing with any form of acetaminophen as she felt “loopy,” at one instance which she did not attribute to any other underlying cause (i.e. fever, medication). Heather also has an aversion to opiates, as she does not tolerate the euphoria and confusion while being on them. The option of bupivicaine +/- corticosteroid was presented to treat her SI join pain and to produce a NSAID sparing effect. However, she is afraid of needles therefore this option was not pursued. Rather a trial of Tramadol immediate release, at a dose of 25-50 mg PO at bedtime was provided to Heather. Her SI joint pain was reduced by 30% (9/10 to 6/10) within 30 minutes of starting Tramadol, without any noticeable side effects. There was no effect on her chronic daily headache pain. She started taking tramadol immediate release around the clock, and wore off after 4 hours. Therefore a prescription for Zytram XL (Tramadol CR) was provided to decrease her baseline pain and address end of dose pain. In addition to she was provided an additional repeat of immediate release tramadol for breakthrough pain. Lastly she discontinued use of ibuprofen as her pain relief from Tramadol was
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