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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Describe the most common signs and symptoms of osteoarthritis (OA).

  • Design an appropriate pharmacotherapeutic regimen for treating OA, taking into account the patient’s other medical problems and drug therapy.

  • Incorporate potential adjunctive therapies (pharmacologic, nonpharmacologic, and alternative) into the regimen of a patient with OA.

  • Assess and evaluate the efficacy of an analgesic regimen for a patient with OA, and formulate an alternative plan if the regimen is inadequate or causes unacceptable toxicity.

PATIENT PRESENTATION

Chief Complaint

“What can I take to help this pain? This new medication has only made me feel worse!”

HPI

Ray Kansella is a 74-year-old man who comes in to see his PCP today complaining of right knee and right hip pain for the past 10 years since he retired from an assembly plant. He often did very heavy lifting in his job and put a lot of strain on his back and legs; now the patient feels he is paying the price for all of his hard work. Mr Kansella wakes up every morning very stiff, and his right knee cracks when he gets up out of bed. The cracking in the joint goes away after he finishes his breakfast, but the aching in his knee and hip persists and chronically bothers him. For several months the patient has been taking scheduled doses of Tylenol Extra Strength. He visited his PCP 3 weeks ago with similar complaints and was prescribed Norco for additional pain management. He reports being given a month supply and taking this new medication three to four times per day. He reports good adherence to prescribed medications; however, he is not sure what medications he has tried in the past; all he knows is that whatever he is taking is not helping. He reports some vague abdominal cramping and intermittent nausea. Additionally, patient complains of lack of energy due to sleepiness during the day and has been unable to do any exercise. He states he is very depressed because he can’t enjoy time with family and his two grandchildren. His PCP wants more aggressive pain management and asking for your dosing recommendation on converting his Norco to a long-acting opioid given his past medical history and limited treatment options.

PMH

OA × 10 years

HTN × 20 years

Obesity × 15 years

Seizure disorder × 12 years (last seizure was 5 years ago)

CKD × 5 years

PSH

Appendectomy 35 years ago

FH

Father died ...

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