Therapy for Clients With Pain and Sleep/Wake Disorders

Week 7: Therapy for Clients With Pain and Sleep/Wake Disorders

From negative changes in mood to problems
concentrating, pain and sleep/wake disorders can have a tremendous
impact on clients’ lives. When clients suffer from these disorders, they
often seek medical care with the intent of receiving medications to
manage symptoms. However, many of the medications used to treat pain and
sleep/wake disorders may be addictive, making thorough client
assessments and close follow-up care essential. To prescribe appropriate
therapies with client safety in mind, you must understand not only the
pathophysiology of these disorders, but also the pharmacologic agents
used to treat them.

This week, as you study
therapies for individuals with pain and sleep/wake disorders, you
examine the assessment and treatment of clients with these disorders.
You also explore ethical and legal implications of these therapies.


Discussion: Sleep/Wake Disorders

It is not uncommon to experience a night or two
of disrupted sleep when there is something major going on in your life.
However, sleep/wake disorders are much more than an occasional night of
disrupted sleep. A recent report from the Centers for Disease Control
and Prevention estimated that between 50 and 70 million American have
problems with sleep/wake disorders (CDC, 2015). Although the vast
majority of Americans will visit their primary care provider for
treatment of these disorders, many providers will refer patients for
further evaluation. For this Discussion, you consider how you might
assess and treat the individuals based on the provided client factors.

Learning Objectives

Students will:
  • Assess client factors and history to develop personalized therapy plans for clients with sleep/wake disorders
  • Analyze factors that influence pharmacokinetic and pharmacodynamic
    processes in clients requiring therapy for sleep/wake disorders
  • Evaluate efficacy of treatment plans for clients presenting for sleep/wake therapy
  • Apply knowledge of providing care to adult and geriatric clients presenting for sleep/wake disorders

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through this link provided.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

  • Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia

  • alprazolam
  • amitriptyline
  • amoxapine
  • clomipramine
  • clonazepam
  • desipramine
  • diazepam
  • doxepin
  • flunitrazepam
  • flurazepam
  • hydroxyzine
  • imipramine
  • lorazepam
  • nortriptyline
  • ramelteon
  • temazepam
  • trazodone
  • triazolam
  • trimipramine
  • zaleplon
  • zolpidem

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.003707. Retrieved from http://bjpo.rcpsych.org/content/2/6/e16

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following case studies to review for this
Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 2, Case #16: The woman who liked late-night TV

Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

Case 3: Volume 1, Case #5: The sleepy woman with anxiety

  • Review this week’s Learning Resources and reflect on the insights they provide.
  • Go to the Stahl Online website and examine the case study you were assigned.
  • Take the pretest for the case study.
  • Review the patient intake documentation, psychiatric history,
    patient file, medication history, etc. As you progress through each
    section, formulate a list of questions that you might ask the patient if
    he or she were in your office.
  • Based on the patient’s case history, consider other people in his
    or her life that you would need to speak to or get feedback from (i.e.,
    family members, teachers, nursing home aides, etc.).
  • Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
  • Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
  • Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
  • Review the posttest for the case study.

Note: For this Discussion, you are required to complete
your initial post before you will be able to view and respond to your
colleagues’ postings. Begin by clicking on the “Post to Discussion
Question” link and then select “Create Thread” to complete your initial
post. Remember, once you click on Submit, you cannot delete or edit your
own posts, and you cannot post anonymously. Please check your post
carefully before clicking on Submit!

By Day 3

Post a response to the following:

  • Provide the case number in the subject line of the Discussion.
  • List three questions you might ask the patient if he or she were in
    your office. Provide a rationale for why you might ask these questions.
  • Identify people in the patient’s life you would need to speak to or
    get feedback from to further assess the patient’s situation. Include
    specific questions you might ask these people and why.
  • Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
  • List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
  • List two pharmacologic agents and their dosing that would be
    appropriate for the patient’s sleep/wake therapy based on
    pharmacokinetics and pharmacodynamics. From a mechanism of action
    perspective, provide a rationale for why you might choose one agent over
    the other.
  • If your assigned case includes “check points” (i.e., follow-up data
    at week 4, 8, 12, etc.), indicate any therapeutic changes that you
    might make based on the data provided.
  • Explain “lessons learned” from this case study, including how you
    might apply this case to your own practice when providing care to
    patients with similar clinical presentations.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two
of your colleagues who were assigned to a different case than you. For
example, if you were assigned to Case Study 1, respond to one colleague
assigned to Case Study 2 and one colleague assigned to Case Study 3.
Explain how you might apply knowledge gained from your colleagues’ case
studies to you own practice in clinical settings.

Submission and Grading Information

Grading Criteria


To access your rubric:Week 7 Discussion Rubric

Post by Day 3 and Respond by Day 6


To participate in this Discussion:Week 7 Discussion


Assignment: Assessing and Treating Clients With Pain

Pain can greatly influence an individual’s
quality of life, as uncontrolled pain negatively impacts mood,
concentration, and the overall physical and mental well-being of
clients. Although pain can often be controlled with medications, the
process of assessing and treating clients can be challenging because
pain is such a subjective experience. Only the person experiencing the
pain truly knows the intensity of the pain and whether there is a need
for medication therapies. Sometimes, beliefs about pain and treatments
for pain can have an adverse effect on the provider-client relationship.
For this Assignment, as you examine the interactive case study consider
how you might assess and treat clients presenting with pain.

Learning Objectives

Students will:
  • Assess client factors and history to develop personalized therapy plans for clients with pain
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for pain
  • Evaluate efficacy of treatment plans for clients presenting for pain therapy
  • Analyze ethical and legal implications related to prescribing therapy for clients with pain

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through this link provided.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

  • Chapter 10, “Chronic Pain and Its Treatment”

Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the Chronic Pain and Fibromyalgia tab.

  • Chapter 5, “Pain Drugs”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia

  • amitriptyline
  • amoxapine
  • carbamazepine
  • clomipramine
  • clonidine (adjunct)
  • desipramine
  • dothiepin
  • doxepin
  • duloxetine
  • gabapentin
  • imipramine
  • lamotrigine
  • levetiracetam
  • lofepramine
  • maprotiline
  • memantine
  • milnacipran
  • nortriptyline
  • pregabalin
  • tiagabine
  • topiramate
  • trimipramine
  • valproate (divalproex)
  • zonisamide

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

National Institute of Neurological Disorders and Stroke. (2016). Pain: Hope through research. Retrieved from http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#3084_2

Required Media

Laureate Education (2016a). Case study: A Caucasian man with hip pain [Interactive media file]. Baltimore, MD: AuthorNote: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

  • Review this week’s Learning Resources. Consider how to assess and
    treat clients requiring therapy for pain and sleep/wake disorders.

The Assignment

Examine Case Study: A Caucasian Man With Hip Pain.
You will be asked to make three decisions concerning the medication to
prescribe to this client. Be sure to consider factors that might impact
the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support
      your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with
      Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support
      your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with
      Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support
      your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with
      Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three
academic resources. While you may use the course text to support your
rationale, it will not count toward the resource requirement.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

  • Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 7 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 7 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submit button to complete your submission.
Grading Criteria


To access your rubric:Week 7 Assignment Rubric

Check Your Assignment Draft for Authenticity


To check your Assignment draft for authenticity:Submit your Week 7 Assignment draft and review the originality report.

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To submit your Assignment:Week 7 Assignment


Making Connections

Now that you have:

  • Assessed clients presenting with pain and sleep/wake disorders
  • Developed personalized plans of therapy for clients with pain and sleep/wake disorders
  • Examined factors that influence pharmacokinetic and pharmacodynamic
    processes in clients requiring therapy for pain and sleep/wake
    disorders
  • Explored ethical and legal implications of prescribing therapy to clients with pain and sleep/wake disorders

Next week, you will build on your
assessment and treatment skills as you examine clients presenting for
therapy for impulsivity, compulsivity, and addiction.
To go to the next week:Week 8

 

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Therapy for Clients With Pain and Sleep/Wake Disorders was first posted on February 3, 2020 at 2:33 pm.
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