Marco Aquino, a 41-year-old male from the Philippines, presents with severe pain in his right first MTP joint that started 2 days ago.

Patient Case Study: Musculoskeletal/Pain

Assignment Content

This week you explored both the musculoskeletal system and pain management. In this assignment, focus on developing the proper treatment plans for two patients presenting with severe pain related to gout and osteoarthritis.

Gout

Read the following scenario to answer questions 1-3:

Marco Aquino, a 41-year-old male from the Philippines, presents with severe pain in his right first MTP joint that started 2 days ago. He suspects it is his “gout flaring up” again because of overindulging in seafood and beer, which he admits. He describes similar episodes of severe pain in the same toe over the past couple of years to the degree he couldn’t walk. He didn’t see a provider but achieved resolution of the pain after a few weeks of ice, rest, and taking an herbal medication from the Philippines. He works as a forklift driver and can’t miss work. He is asking what he can take to achieve more rapid relief of his symptoms. He takes no other medications and has no known allergies. His labs are all normal. 

Question 1

All of the following are appropriate medication options to prescribe for George’s acute gout attack except for which of the following?

Indomethacin

Prednisone

Colchicine

Probenecid

Question 2

Marco has agreed to take allopurinol, a xanthine oxidase inhibitor daily. Educating Marco about titration of the medication to a therapeutic dose is important. The goal is to treat to a serum uric acid level of what?

The “normal” uric acid level outlined by the laboratory conducting the testing

Less than 6mg/dL

Less than 8mg/dL

There is no specific uric acid level treatment goal; only need to achieve resolution of symptoms.

Question 3

Which of the following labs is the least important to monitor while Marco is on anti-gout medications?

Liver function

Renal function

CBC

Uric acid

Question 4

Which of the following is the most appropriate treatment for Tracie at this point?

Scheduled dosing of acetaminophen in combination with topical capsaicin

Scheduled dosing of oral NSAIDs with mild opioid for breakthrough pain

Topical NSAID pain relief with mild opioid for breakthrough pain

PRN dosing of acetaminophen

Question 5

Tracie asks about alternative treatments. All of the following are true except:

Systematic reviews done on glucosamine revealed a significant reduction in knee pain.

Topical NSAID pain reliever is generally considered a safer alternative to oral therapy; however, it still requires liver function monitoring.

Beneficial interventions include stretching, yoga, acupuncture, weight reduction, and gradual conditioning of major muscle groups.

Injection options include steroids, hyaluronate, and viscous solutions.

Question 6

Tracie returns 1 year later and she indicates her daily pain is now 7/10 despite using acetaminophen, NSAIDS, topical medications, physical therapy, massage, ice, and rest. She is currently using ibuprofen 800mg TID with food, capsaicin topical to her knee, and adds acetaminophen prn. The pain interferes with her quality of life and sleep. She plans to have a total knee replacement done, but her surgery is scheduled 2 months out. She is requesting stronger pain medicine until she can get her surgery done. According to the World Health Organization “pain ladder,” which is the most appropriate medication to add for Tracie?

Ketoprofen

Oxycodone

Tramadol

MS Contin®

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