Ssi Joint Pain Case Studies

Based on the progress report dated 12/10/15, the patient reported that she is taking tramadol with good relief and tolerating it well. She states that her pain levels are 6-7/10 without medication and 3-4/10 with medication.

At today’s visit she is seen at Tiffany hall SNF. She is found in her room. She is awake and alert and oriented. She c/o of pain in her hips and knees, that she describe as achy with a severity of 5/10, the pain does not radiate but does affect her ability to ambulate, she is using a wheelchair. Her pain regimen is Lortab 7.5 mg p.o every 4 hours. She reports that she has increased hip pain when she sleeps on her mattress because she sinks in her mattress. She is schedule to follow up with her orthopedic doctor Dr. Shute.

Anne is currently taking paracetamol for the pain in her wrist, within healthcare analgesia should always be monitored to assess whether it is achieving elimination of pain and should be adapted to the individual patient (Vargas-Schaffer, 2010). If paracetamol were not effective in eliminating Anne’s pain then practitioners should consider a non-steroidal anti-inflammatory medication [NSAIDS] or a mild opioid medication such as codeine as the next step (Vargas-Schaffer, 2010). However as Anne is asthmatic NSAID medication should be used with caution due to the risk of increased frequency of asthma attacks and breathlessness (Joint Formulary Committee, 2015); if Anne has taken NSAIDS before with no issue then this would be the next choice of analgesia followed by codeine if combined paracetamol and NSAID did not prove effective (Vargas-Schaffer,

Opioid-induced adverse effects are a very interesting topic and does play a big part in patient safety. It’s estimated that more than half of older adults who reside in a healcre related community have a chronic pain disorder, with the long-term care setting rate of prevalence substantially increased (up to almost 90%). Physicians across all care settings are tasked with the daunting challenge of providing pain relief while, at the same time, minimizing opioid-induced side effects. Some of the common opioid-induced side effects are Constipation, Nausea, Vomiting, Pruritus, Sweating, Sedation, Fatigue, Headache, Delirium, Confusion, Clouded vision, Dizziness, Xerostomia, Postural Hypotension, Bladder Dysfunction such as Urinary Retention,

Tramadol, (1RS,2RS)-2-[(dimethylamino)-methyl]-1-(3- methoxyphenyl)-cyclohexanol is a synthetic, centrally acting analgesic used both parenterally and orally for the treatment of moderate to severe pain[1-3].It has dual mechanism of action; weak agonistic effect at the μ-opioid receptor, as well as inhibition of monoamine(serotonin, norepinephrine) re-uptake[4]. In healthy volunteers, oral tramadol 100mg provided superior analgesia compared with placebo. The peak analgesic effect occurred 1 to 4 hours after drug administration, with analgesia persisting for 3 to 6 hours[5].

Many of these drugs are used temporarily to “reset one’s pain control” and are not necessary for long term use. Wallace, D. J. & Wallace, J.B., (2002)

As the difficulty of analgesic therapies rises, establishment of the priorities of care must be forced in order to avert or diminish adverse events from occurring and to ensure that high quality and safe care is followed through. Opioid analgesia, in particular, remains to be the main primary pharmacologic intervention for managing pain in hospitalised patients. Although, while opioid use is generally safe for most patients, it may be associated with adverse effects, the most serious and severe opioid-related adverse event being respiratory depression (Davies et al.

Chronic pain is often concurrent with depression and many agents used for the treatment of depression are CYP2D6 inhibitors which interfere with the metabolism and pharmacological action of tramadol, a common agent used in the treatment of moderate to severe pain. The case reported is proposes caution should be taken in initiating or titrating tramadol in patients currently taking medications with strong CYP2D6 inhibition properties, especially in combination with other serotonergic agents. A 70-year-old female presented with signs and symptoms of mild serotonin toxicity resulting from an increased tramadol dose in concurrence with bupropion and sertraline therapy. The offending agents, tramadol and bupropion, were discontinued eliminating

Are you someone who experiences joint pain frequently? Treatment for the pain can involve medicines that are prescribed or are an over-the-counter product. However, a natural remedy will be better for the elimination of discomfort. The best thing to do is use lemon peels for point pain.

At today's visit, she is accompanied by her daughter. The daughter reports that the patient continues to have a flat affect and express hopelessness. The patient complains of increased lower back pain, which she describes as dull pain that does not radiate, severity of 5/10. Her pain is worse with movements. The daughter reports that the patient has not been taking her tramadol as order. The daughter reports that the patient has unrelieved anxiety and insomnia if she does not take her

Gabapentin at low dose of 300mg/day reduces the frequency and intensity of headache[11], dose is gradually increased to total of 900mg/day in three divided doses. Then it can be increased gradually to another target dose of total 1800mg/day in 3 divided doses. Frequent dosing is its disadvantage but few adverse effect is its advantage. Dose adjustment is required in case of renal insufficiency and the medication is contraindicated in child below 12 years of age. Topiramate at 25 mg PD is very effective migraine prophylactic agent[12] increasing weekly to a goal of 100-200 mg BID. Patient must be monitored for metabolic acidosis and

Furthermore, medications such as analgesics, non-steroidal anti-inflammatory (NSAIDs), corticosteroids, and opioids are mostly prescribed by the providers to manage symptoms despite their long-term adverse effects. People with OA often suffer with depression, diabetes, hypertension, falls, obesity, and sleep disturbances. In addition to that, chronic dependency on NSAIDs, opioids, and steroids further leads to adverse events which in turn increase the morbidity and mortality rates in this age group (Johns Hopkins Arthritis Center, 2011). Additionally, recent tightened rules on the availability of hydrocodone combo pills by the DEA (Vicodin, Lorcet) emphasize the issues associated with overdosing and medication abuse among OA patients (Arthritis Foundation, 2014). Moreover, the medications relieve pain symptoms however, do not add any protection to the joints, which in the long run leads to further damage of the joint and

From our clinical expertise, we discourage the use of opioids, for the potential risk of opioid-induced-hyperalgesia (64), dependency and possible addiction (65). Nixdorf et al., suggest to follow the NICE guidelines (National Institute of Health Care and Excellence) for the treatment of peripheral neuropathic pain: oral medications, topical when practical and avoid irreversible treatments that involve local injury (29).

It is a hard decision for health care providers to decide the best pain medication for their patients, as there are many types and strength of painkillers. After taking that into consideration, the practitioner have to decide on the length of duration to ensure that patients do not slowly develop tolerance to their specific pain medication. Lastly, they have to be cautious that patients do follow their instruction to prevent possible abuse and withdraw from the addictive painkillers. The use of painkillers is ideal for acute pain, and not for chronic pain. Patients should always find alternatives before submitting themselves into using pain medications. Painkillers should be used as a last resort, and healthcare providers should have second thoughts before prescribing any addictive painkillers that may result in abuse. It is their duties to monitor the patient regularly and ensuring that the medications are not being used for recreational purposes. Healthcare providers are the patient’s best advocates and they have to carefully decide the best suitable pain treatment for their

Migraine is a common episodic headache disorder often associated with an impaired quality of life. Preventive, prophylactic treatment of migraine should be considered for patients who are significantly disabled by attacks and unresponsive to acute rescue treatment, and for those who respond to acute treatment but experience frequent attacks, as there is an increased likelihood of drug induced (rebound) headache in this population. An example of a prevention trial is treating a group of patients with migraines with 100mg/day topiramate in double-blind, placebo-controlled trials (Silberstein, 2004). Response rates were high, and onset of action usually occurred within the first month of treatment. Evidence from large, well-conducted,