Ssi Joint Pain Case Studies

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,

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.

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)

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

10/22/15 Pain management report by Dr. Saidov reported the patient has knee pain. The pain radiates up and down the left leg. The patient describes the pain as burning, aching and dull. The patient reports that the pain is 9/10-scale level on her worst day and 3/10-scale level on her best day. Bending forward, sitting, standing, and walking aggravate the pain. Medications relieve the pain. She has been previously treated with pain medications and PT. The PT was ineffective in controlling the pain. Tramadol was effective. The patient reports no side effects to the medications and states that her functional status improves and her pain is controlled with the medication. The patient is afraid to proceed with the SCS trial secondary to the fear of getting RSD in her spine. The patient admits having sleeping problems. Exam of the left lower extremity revealed decreased temperature in the left knee. There were parasthesias and signs of allodynia in the left leg. Knee stability was decreased on maneuvers and there was severe restricted ROM in all planes. Treatment plan included medication refill for gabapentin, tramadol, clonidine, lidocaine topical and pamelor oral. Follow-up in 1 month.

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

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

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].

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.

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.

Puzzled by what was the working force behind this drug, which was known for its healing properties, I did my own reading and discovered the effects of its abuse. Analgesics are known to relievemost conditions such as fever and inflammation. However, at higher dosages, they are known to cause greater complications in the long run. This motivated me to become someone who can guide patients in taking a safe dosage of the right medication by aiding them to understand the mechanism of medicine on different people. Given the credibility as a pharmacist, I will be dealing directly with patients and plan to provide patient-centered care in improving their health. Additionally, my love for ideas will allow me to design, implement and assess initiatives to further ameliorate

Aleve, Naprosyn, ibuprofen, and she complains of gastrointestinal upset from NSAIDs. The patient also has herbal topical analgesics for knee pain. It was noted further that the patient failed the trial for Norco 5/325 mg due to gastrointestinal upset. Soma is also discontinued. It was noted as well that the Voltaren gel is helping more than the Lidocaine ointment. The patient has allergies to sulfa drugs, aspirin, penicillin, and Fosamax. The 4 A’s of pain management is reviewed and notes that the pain is reduced to a tolerable level; activities of daily living are better/able to exercise/do house chores and laundry; denies any side effects; and that the patient is taking the medication as directed. Lumbar spine examination revealed that there is diffuse tenderness to palpation over the midline at L3-S1; diffuse bilateral tenderness at the lumbosacral paraspinal region at L3-S1; and diffuse tenderness with tightness over the thoracolumbar paraspinal muscle approximately from the T9 down to the L2 level as estimated by the provider. There is myofascial tenderness and tightness over the paraspinal

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