There have been a few patients over the past few weeks come in with a complaint of chronic pain, wether it be all over the body, chronic neck pain or chronic headaches. The problem is how do you treat a pain that has no real cause?! (or one that we cant observe).
Patient A
Has had chronic headaches that last from 30seconds to 5 minutes that are felt around the temple region. A common cause of headaches is neck pain, however it's not the case here.
It could be Temporal Arthritis, which is an inflammatory disease of the blood vessels involving the large arteries of the head, but the patient did not have prominent temporal arteries on palpation of them.
So it was decided to prescribe the patient a drug to help with her chronic pain:
AMITRIPTYLINE - A drug that can be used for tension headaches, migraines and depression. Side effects include drowsiness and a dry mouth. But you would only take the drug at night due to it's sedating effects.
An interesting fact from the Dr - 99% of all headaches aren't brain tumours, and 90% of brain tumours don't present with headaches!
Patient B
Has suffered from chronic head, neck and shoulder pain for 15 years. She is currently taking
PREGABALIN - is an anticonvulsant drug as well as being used for neuropathic pain, and has been shown to be effective in treating chronic pain such as fibromyalgia. Side effects may include dizziness and drowsiness in some patients.
The patient has found that it hasn't cured her pain, just taken the edge off it.
So it was decided to change her treatment and try a different drug, this time it was DUALOXETINE, the patient will be slowly weened off Pregabalin over a week and then start taking the new drug to see if it helps! :)
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