From the Guidelines
I recommend managing the patient's left arm pain and numbness with ibuprofen 400 mg three times daily as needed and amitriptyline 25 mg at bedtime, as this approach addresses both inflammatory and neuropathic components of pain, in line with the guidelines for pharmacological management of neuropathic pain 1. While the patient requested a softer mattress or topper based on previous relief and his son's advice, he does not meet Centurion's guidelines for mattress accommodation. Since the patient works in the kitchen performing repetitive motions, I suggest he rotate to different positions to reduce strain. Additionally, I've ordered vitamin B12 and TSH labs to rule out potential deficiencies or thyroid issues that could contribute to his symptoms. The ibuprofen will help reduce inflammation and pain, while amitriptyline can address neuropathic pain components and improve sleep quality, as supported by the recommendations for the pharmacological management of neuropathic pain, which suggest initiating therapy with a secondary-amine TCA, such as amitriptyline, or an SSNRI, such as duloxetine or venlafaxine 1. This combined approach of medication, job modification, and diagnostic testing should provide relief while we identify any underlying causes of his symptoms. The patient has agreed to this plan of care. It's also important to note that the use of nonsteroidal anti-inflammatory drugs, such as ibuprofen, should be considered with caution, taking into account the patient's overall health and potential risks, as highlighted in the guidelines for the use of nonsteroidal anti-inflammatory drugs 1. Furthermore, the management of pain should prioritize a comprehensive approach, including assessment of the likely etiology of pain, pain location, quality, quantity, duration, and intensity, as well as what aggravates or relieves the pain, in accordance with the recommendations for pain management in adult stroke rehabilitation care 1.
From the Research
Patient Complaints and History
- The patient is a 61-year-old male with complaints of left arm pain and numbness.
- The patient's son, a neurologist, advised him to use a soft mattress, which helped in another prison.
- The patient works in the kitchen, performing repetitive motions with his right arm.
Medical Evaluation and Treatment
- The patient does not meet Centurion's guidelines for mattresses.
- The patient agreed to the evaluation results.
- The patient was recommended to rotate to another position at his job to avoid repetitive motion.
- The patient was prescribed ibuprofen 400 mg TIDPRN and amitriptyline 25 mg QPM for pain management, as supported by studies on ibuprofen's efficacy and safety 2.
- B12 and TSH labs were ordered to rule out underlying conditions.
Potential Causes of Left Arm Numbness
- The patient's symptoms could be related to nerve conduction issues, as discussed in studies on nerve conduction and electromyography 3, 4, 5.
- The patient's history of repetitive motion could contribute to nerve damage or compression.
- Other potential causes, such as cardiovascular disease, should be considered, as left arm numbness can be a symptom of cardiac-related issues 6.