What is the appropriate management for a patient with left lower quadriceps pain and swelling, currently using a liniment for horses, who reports improvement and has a pain level of mild pain (3/10)?

From the FDA Drug Label

The use of diclofenac sodium topical solution for the treatment of pain of osteoarthritis of the knee was evaluated in a single double-blind controlled trial conducted in the US, involving patients treated with diclofenac sodium topical solution at a dose of 2 pumps twice a day for 4 weeks The patient is using a liniment for horses, but the provided drug labels are for diclofenac (TOP) and capsaicin (TOP). Since the patient's medication is not explicitly mentioned in the labels, no conclusion can be drawn about the effectiveness or safety of the patient's current treatment. The patient's report of improved pain (3/10) and swelling in the left lower quad cannot be directly linked to the provided drug labels.

• The patient's request for a water pill is unrelated to the provided information about topical pain treatments. 1

From the Research

I recommend continuing the current treatment plan with the horse liniment for left lower quadrant pain, which appears to be providing relief as the patient reports improvement to 3/10 pain level. Regarding the water pill request, I would prescribe hydrochlorothiazide 12.5mg daily as an initial dose, which can help reduce any swelling the patient is experiencing, as supported by the study on diuretic use in renal disease 2. The patient should take this medication in the morning to avoid nighttime urination disrupting sleep. Side effects may include increased urination, electrolyte imbalances, and dizziness, as noted in the study on the pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs 3. The patient should monitor for significant improvement in swelling within 1-2 weeks. It's essential to maintain adequate hydration while taking diuretics, but avoid excessive fluid intake, as highlighted in the study on the safe and appropriate use of diclofenac in chronic kidney disease 4. The patient should follow up in one month to assess the effectiveness of the diuretic therapy and determine if any dosage adjustments are needed. Some key points to consider when prescribing diuretics include:

• Diuretics work by increasing sodium and water excretion by the kidneys, which reduces fluid retention and swelling throughout the body 2.
• The use of non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of nephrotoxicity, especially in patients with pre-existing renal disease 3.
• Diclofenac may be well tolerated in patients with renal impairment when used at the lowest effective dose for the shortest duration 4.
• The patient's renal function should be closely monitored while taking diuretics, especially if they have a history of renal disease or are taking other medications that may affect renal function 5, 6.