Complex Regional Pain Syndrome Decision Tree

The management of the condition can lead to remission or an improvement in symptoms. The patient in the case study presented with pain on the right limb that was out of proportion to the fall that he had had, this pain was significant and interfered with his day to day life as well as his social interactions and self-care. The pain was not associated with any illness or drug/ substance abuse. Decision 1 The options that were available for the initial management of the patient included; oral Savella 12. 5 mg once daily and with an increase in the dosage up to day 7 of the treatment, Amitryptlyne25mgorally QHS titrated upward weekly by 25 mg to a maximum 200mg dosage per day and Neurontin 300 mg per oral at bedtime with an increase of 300 mg per day to a maximum of 2400 mg if needed.

The adverse effects of the medication were expected but should not be troublesome to the patient and can be managed with a change in the administration time. Decision 2 The available decisions for the management of the patient are to increase the dosage of the amitriptyline to 125 mg dosage at bedtime with dose tapering towards 200 mg maximum dosage and change the dosage to an hour earlier and report on his morning condition to the clinic in 3 days. Reduction of dosage to 75 mg and add Bio freeze roll on the affected leg. Reduction of the dosage to 75 mg oral and adding Neurontin 300 mg oral at bedtime with follow-up on phone. I chose to continue the Amitriptyline with an incremental dose of 125 and increase the dosage towards 200mg with earlier medication by an hour to manage the drowsiness experienced in the morning.

75mg/23mg tablet daily. Reduce the dosage from 125 mg to 100 mg and follow up the patient in a months’ time or continue the medication dose and refer to a life coach for counselling on diet and exercise. As the PMHNP caring for the patient I chose to continue the medication dosage at 125 mg and refer to the life coach for counselling on diet and exercise. The patient is already responding well to the treatment with reduced pain and improved social functioning. There is no need for dose adjustment as a reduction may lead to reduced pain control. , & Wiffen, P. Amitriptyline for neuropathic pain in adults.  Cochrane Database of Systematic Reviews. doi: 10. cd008242. , Maier, S. , Weitz, J. , & Siepmann, T. Adverse Effects of Antidepressants for Chronic Pain: A Systematic Review and Meta-analysis.