Chronic Pain - Sample Research Answers

What nondrug therapies might be useful for this patient?

Research suggests that the nondrug therapies that are effective in treating OA includes physical activity, patient education, support and physiotherapy. Patients such as Ruth Adams can successfully control and improve their OA and chronic pain through physical activities, self-help and dietary changes. The following nondrug therapies can help Ruth to manage her OA, hip pain and her overall physical health.

Exercise: Firstly, it is recommended that that Ms Adams engages herself in exercise in order to improve her health and to control the pain associated with OA. For this purpose, it is recommended that the patient engages herself in low impact exercise. The goal of exercise in terms of OA is to improve health, flexibility, strength and endurance. Since Ruth at the mild stage of OA, exercise can help her to improve her overall health condition and would reduce her hip pain as well keep her blood pressure and insulin levels under control. Ruth can also do aerobic exercise such as swimming and walking in order to improve her physical health. According to Edmunds & Mayhew, physical activity can be beneficial in improving the physical condition of OA patients and it is the key in managing the disease. Ruth suffers from stiffness, restricted motion and hip pain and therefore, it is recommended that she enrolls herself in an exercise program.

Self-Help: Ruth can take full advantage through self-help techniques and would help in improving her physical, emotional and psychological health. Self- help techniques include self-help courses, which are aimed at providing education to patients suffering from OA (Osteoarthritis, 2014).

Physical Therapy: Manual therapy can be used by Ruth in order to manage the knee pain and stiffness. It is a physical therapist technique, which removes joint stiffness through movement passive in nature. Therapists use passive techniques such as stretching the joint to the opposite surface. Physical therapists may also include therapies to improve balance, flexibility and coordination (Edmunds & Mayhew, 2003).

What feasible pharmaco-therapeutic alternatives are available for treatment of this patient?

The pharmacotherapeutic alternatives for the patient include Fosamax 10 mg po daily, Celebrex 50 mg po daily, Vitamin D 400 iu daily, calcium chloride 100 mg daily, Tramadol 50 mg after 6 hours and should not exceed 300 mg/daily, capsaicin cream and Gabapentin 900 mg.

Fosamax belongs to the bisphospohonate class and it is used to treat OA. After menopause, the bone losses its density and therefore, it has been prescribed to improve the density of bones and to decrease the risk of fracture. Calcium supplements have the ability to impact the absorption of Fosamax and therefore, it is essential that it is taken 30 minutes before consuming calcium supplements (Medscape Drug Interaction Checker, 2014). If this medicine is taken with aspirin or NSAIDS, there is possibility that the patient may suffer from stomach and intestinal issues.

Celebrex 50 mg po daily dosage has been prescribed for OA and to ease the symptoms of OA. Tramadol 50 mg po daily has been prescribed after every 6 hours but should not exceed 300 mg/daily. It has been recommended because Ruth suffers from moderate pain in the hip and knee. It is well tolerated (Medscape Drug Interaction Checker).

Capsaicin cream has been recommended and to be applied in order for knee pain. Vitamin D (400 international units) and Calcium chloride (100 mg/day).

What drug, dosage form, schedule, and duration of therapy are best for treating this patient’s osteoarthritis?

The initial treatment and dosage for the patient is described as follows: Fosamax 10 mg po daily, Celebrex 50 mg po daily, Vitamin D 400 iu daily, calcium chloride 100 mg daily, Tramadol 50 mg after 6 hours and should not exceed 300 mg/daily, capsaicin cream and Gabapentin 900 mg. The patient suffers from chronic pain and therefore, the schedule has been designed accordingly.

Celebrex 50 mg po daily dosage has been prescribed for OA and to ease the symptoms of OA.

Tramadol 50 mg po daily has been prescribed after every 6 hours but should not exceed 300 mg/daily. It has been recommended because Ruth suffers from moderate pain in the hip and knee. It is well tolerated.

Capsaicin cream has been recommended and to be applied in order for knee pain. Vitamin D (400 international units) and Calcium chloride (100 mg/day).

What alternatives would be appropriate if the initial therapy fails or cannot be used?

The following alternates would be appropriate if the initial therapy fails:

Personalized Physical Therapy Program: If the initial therapy fails, it is suggested that the patient engaged in personalized therapy program to improve her conditions. Research suggests that individuals suffering from OA suffer pain in knee and hip and are unable to move. Physical therapy program for Ruth be specific and aimed at improving balance, coordination, flexibility and increasing physical strength. The specific personalized physical therapy program can help Ruth to perform her daily activities. Another suggested technique is knee taping technique, which can be used to reduce the knee pain. Knee taping technique is self-management technique and has been proven to be effective.

Surgical Option: If all the above techniques fail, it is recommended that the patient opts for joint replacement, which can be beneficial for the patient. It can help in improving the overall quality of life of the patient.

References:

Edmunds, M. & Mayhew, M. Pharmacology for the primary care provider. St Louis, MO: Elsevier Mosby.

Medscape Drug Interaction Checker.