Decision Tree for Neurological and Musculoskeletal Disorder/Complex Regional Pain Disorder

Decision Tree for Neurological and Musculoskeletal Disorder/Complex Regional Pain Disorder



            The assigned case study demonstrates an adult Caucasian male, at the age of 43 years with pain as the main chief complaint. He reports using crutches as support to promote movement. The patient’s family doctor however claims that the patient’s pain is mental rather than physical. The physician reports that most of the patient’s symptoms are made up, as he is only trying to get narcotics. The patient reports that he started experiencing the pain about 7 years ago when he fell at his work and landed on his right hip. Mental evaluation outcome, in combination with the above presentation, led to a primary diagnosis of complex regional pain disorder (reflex sympathetic dystrophy). Several factors including the patient’s diagnosis, presenting symptoms, age, Caucasian race, and male gender will be utilized in the development of the patient’s care plan.

Decision Point One

            The initial intervention was to administer 25mg of amitriptyline per oral every night and gradually increase the dose at intervals of 25 mg every week, not exceeding a maximum dose of 200mg/day. Previous evidence reveals the great effectiveness of amitriptyline in the treatment of complex regional pain disorder, with a rating of 6.6/10 (Javed & Abdi, 2021). Neurontin and Savella were inappropriate with this patient given that the former is unable to manage other symptoms of CRPD other than pain, as the latter would result in insomnia (Eldufani et al., 2020). The patient is expected to display complete remission of symptoms and ambulation without support within four weeks, with great compliance and adherence to the prescribed medication (Handa, 2021).


Decision Point Two

The second intervention was to encourage the patient to continue taking amitriptyline at a dose of 125 mg every night. According to Suer and Sehgal (2021), attaining the optimum therapeutic dose of amitriptyline can take between 4 to 8 weeks, with the patient being able to completely manage their symptoms within 8 to 12 weeks. The patient displayed great tolerance and adherence to the medication, with the only side effect being a groggy feeling in the morning that can be managed by taking the drug at least one hour before going to bed (Handa, 2021). Lowering the dose of amitriptyline, and introducing Bio freeze roll-on therapy was not necessary as the patient needs long-term therapy, rather than a temporary intervention. Adding Neurontin was also inappropriate given that amitriptyline is considered safer (Taylor et al., 2021). The patient’s symptoms are expected to reduce even further with no groggy feeling the following morning for the next four weeks.

Decision Tree for Neurological and Musculoskeletal Disorder Complex Regional Pain Disorder

Decision Point Three

            The final decision was to advise the patient to continue taking 125mg of amitriptyline every night and refer him to a life coach for appropriate dietary interventions and physical activity/exercise. The patient reported improved pain symptoms, with no groggy feeling the following morning with the previous intervention. This shows the great effectiveness of the drug (Javed & Abdi, 2021). He, however, complained of gaining weight which is a common side effect of the medication that is usually managed with non-pharmacological intervention to promote a positive outcome for the patient (Handa, 2021). Reducing the dose of amitriptyline or introducing a new drug to the patient current regimen would only complicate the adherence and tolerance level of the patient and lead to new side effects with a negative outcome  (Suer & Sehgal, 2021). However, with this intervention, the patient’s body weight is expected to normalize with complete remission of symptoms within the following four weeks (Eldufani et al., 2020).


Eldufani, J., Elahmer, N., & Blaise, G. (2020). A medical mystery of complex regional pain syndrome. Heliyon6(2), e03329.

‌Handa, R. (2021). Complex Regional Pain Syndrome. In: Clinical Rheumatology. Springer, Singapore.

Javed, S., & Abdi, S. (2021). Use of anticonvulsants and antidepressants for treatment of complex regional pain syndrome: a literature review. Pain Management11(2), 189–199.

Suer, M., Sehgal, N. (2021). Complex Regional Pain Syndrome and Post-herpetic Neuralgia. In: Questions and Answers in Pain Medicine. Springer, Cham.

Taylor, S.-S., Noor, N., Urits, I., Paladini, A., Sadhu, M. S., Gibb, C., Carlson, T., Myrcik, D., Varrassi, G., & Viswanath, O. (2021). Complex Regional Pain Syndrome: A Comprehensive Review. Pain and Therapy10(2), 875–892.


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Important information on Writing a Discussion Question

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  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
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