MP’s complaint

MP's Complaint and Background Information

MP's complaint about back, hip, and knee pain paints a rudimentary picture of what they may be experiencing. His age adds context as well. The patient would supply further information on the type of discomfort in order to gain insight into the disease's progression. He would also be required to supply further information regarding the occurrence of symptoms related to his posture or activity. If he feels pain when moving, it indicates that the disease is in the joints, however if he feels pain while resting, it indicates infection of the nearby tissues as well.

Further Information and Tests

In addition, the patient would supply more information about their stability. This would enable the caregiver to understand the extent of muscle weakening. The MP should be assessed for crackling and creaking during movement. Additional tests performed on MP would include imaging tests such as X-rays, Magnetic Resonance Imaging, as well as a lab tests e.g. blood tests, and joint fluid analysis. The MRI would provide a more comprehensive understanding of the problem as it will avail detailed images of the bones and soft issues (McAlindon et al., 2014). A small amount of fluid may be drawn from the subject’s knees for testing.

Disease Diagnosis

The patient most probably suffers from osteoarthritis. This is indicated by unique symptoms such as crepitus, tenderness on palpation on the right and left knees, as well as stiffness and radiating pain in the back, knees, and hips.

Treatment Options

MP can be given Synvisc-One injection. The injection contains hyaluronan that acts both as a shock absorber and lubricant as well as a pain relief. It is a single dose treatment and may be reviewed in time by the doctor.

Pain Management and Treatment

The treatment of osteoarthritis is primarily based on pain management. Some of the most effective treatment regimens include the use of acetaminophen, duloxetine, and Nonsteroidal anti-inflammatory drugs. The minimum dosing period for acetaminophen is every four hours. For adults above 50kg in weight and six hours for those who weigh below this (McAlindon et al., 2014). The maximum single dose is 1000mg with the maximum daily dose being 4000mg. people under 50kg should take 15mg/kg with similar intervals. The drug is administered orally or rectally.

In the treatment of osteoarthritis, the use of Nonsteroidal anti-inflammatory drugs is often commonly employed. The most common NSAIDs used for this purpose is ibuprofen (McAlindon et al., 2014). The initial dose should be 400 to 800mg taken orally every 8 hours with the maintenance dose being increased to a maximum daily 3200mg. This is based solely on the patient’s response and tolerance.

Fibromyalgia

The EP presents an interesting perspective to the argument of the use of opiates in the treatment of fibromyalgia. Hydrocodone is a perfectly effective medication for this problem. However, recent studies show that that it may result in adverse outcomes especially in FM patients. In a survey conducted among patients over the internet in 2007, a measly 44% of the respondents rated hydrocodone as effective(Clauw, 2014). A majority of those who perceived the drug to be efficient believed it was best suited for short-term pain relief. Questions were raised about its ability to be used in the long term.

FM patients on opioid treatment we noted to be in worse shape in the course of the treatment than when they started. They were in more pain and exhibited vivid signs of depression and general dysfunctionalities. They experienced higher levels of pain. This explains EP’s complaint that the hydrocodone she was offered doesn’t appear to work. In some patients, opioid increase pain instead of reducing it in a process referred to as opioid-induced hyperalgesia. It is paramount that the patient understands that their seeming non-reaction to the drug is as a result of this effect. EP should understand besides being at the risk of addiction to the medication, they may experience drowsiness and constipation, all of which would have been tenable should the drug have been effective for long-term use.

Consequently, a refill would not be the best option for EP. Instead, amitriptyline, ibuprofen, and pregabalin would be the most apt substitutes. The decision to employ the use of the three is inspired by the reality that fibromyalgia is manifested by a plethora of symptoms, each different in its own way. As such, they ought to be addressed separately. Nonsteroidal anti-inflammatory drugs such as ibuprofen relieve the pain while Lyrica (pregabalin) is an anti-seizure drug.

Tapering-Off Hydrocodone

As much as they provide effective pain relief and other key medical advantages, opiates present a huge challenge, addiction. According to Clauw (2014), patients are often easily hooked to prescription opiates such as oxycontin, Percocet, and vicodin often with grave withdrawal complications. Perhaps more disappointing is the fact that hydrocodone has no significant long-time effect on fibromyalgia. As such, patients would be addicted to medication that has no impact on their condition. In fact, it would make them worse through opioid-induced hyperalgesia. Hydrocodone is particularly difficult to taper off especially after long-term use (Clauw, 2014). Though patients can get off by their own devices, it is often advisable to seek the assistance of a medical practitioner. Some patients, as in the case of the EP, may not even be aware they need to undergo this process. As such, it is paramount that it occurs with the most minimal disruption to their lives.

The first stage of the tapering exercise is to establish a suitable strategy. The patient suffers from fibromyalgia. Therefore, it is critical that alternative medication for her condition be developed. She will be provided with amitriptyline, ibuprofen, and pregabalin to substitute the hydrocodone. Additionally, the strategy should include a timeframe for the taper. Slower tapers may be easier for the patient to handle but take a longer time. Furthermore, their administration is immensely logistically challenging. Faster tapers may not work as coming off a powerful opioid such as hydrocodone significantly stresses the patient’s body and increases the risk of relapsing. The type of taper used depends on the patient’s will. If she intends to wean off in a month, she may take her usual 75mg in the first week, 50mg in the second week, 25mg in the third week, and 5mg to 0mg in the final week.

The body would readjust to the reduction in the intake primarily because of the patient’s resolve. A slower one would feature the use of the same drug proportions but over an extended period such as a month instead of a week. For a fibromyalgia sufferer, a fast taper may be suitable for the primary reason that hydrocodone’s effects such as pain and dysfunction will persist and interfere with the treatment process (Clauw, 2014). The patient will then be encouraged to assume procedures as meditation, Dimethyl sulfoxide, and anti-inflammatory foods such as turmeric, ginger, juice concentrate, and fish oil in place of narcotics.

References

Clauw, D. J. (2014). Fibromyalgia: a clinical review. Jama, 311(15), 1547-1555.

McAlindon, T. E., Bannuru, R., Sullivan, M. C., Arden, N. K., Berenbaum, F., Bierma-Zeinstra, S. M., ... & Kwoh, K. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and cartilage, 22(3), 363-388.