Non-pharmacologic
Pam learned from her support group that mild hot and cold compresses used regularly could help with her musculoskeletal symptoms. She additionally received a transcutaneous electrical nerve stimulator (TENS) device, which she believes is providing some relief when she remembers to use it. She is interested in learning more about dietary modifications and is asking today about some dietary supplements she read can be beneficial for neuropathy.
Pharmacologic
Pam was initiated on gabapentin, which she believes provided relief for her neurogenic pain symptoms. She has since had duloxetine added to her regimen and her pain severity has reduced. She is now on oxycodone and acetaminophen IR only and averages one to two doses weekly. She is no longer taking the lorazepam at night.
Emotional
Well-Being In addition to her support group, Pam has been seeing a counselor alone for help with body image, anxiety, depression, and coping strategies. She and her husband complete six sessions of couples’ therapy from a specialist.
Functional/Rehabilitation
At her primary care provider’s urging, Pam returned to physical therapy and completed a full treatment course. She continues to have some mild functional limitations but has made significant improvement in strength and range of motion. She did not have lymphedema. She is once again playing with her kids.
Drug-Related Problems
Pam was successfully weaned down on her oxycodone doses and reported improvement in daytime fatigue and sedation. Her nausea improved as well. At her pharmacist’s request, the lorazepam was discontinued and she required no further sleep aids. While she eventually received a naloxone coprescription, her new opioid dose is well below the cut-off for consideration. She still has not purchased a lock-box for her controlled medications.
