Case Study Ulcerative Colitis

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Recommended: Post-operative pain can be treated using various pharmacological interventions such as

Pre-operative:
The patient is young, female, has preoperative pain, has a history of anxiety and depression and is already catastrophizing about having her left wisdom teeth extracted. These are all pre-operative risk factors for transitioning from acute to chronic postoperative pain ( Shipton, 2011). The patient also has a history of anxiety and depression which is a risk factor for developing painful temporomandibular disorder (TMD) (Fillingham, Ohrbach, Greenspan...Maixner, 2013). The patient has a recent diagnosis of ulcerative colitis, which has been identified as a risk factor for developing TMD (Slade, Fillingham, Sanders ... Maixner, 2013). She has been taking Pentasa for 3 weeks for ulcerative colitis and has been taking Cymbalta …show more content…

The patient should also be re-examined to assess for nerve damage (Shipton, 2011). Once the patient is stable, she should be discharged with prescriptions, educated and given instructions to call the clinician if her pain is not properly controlled, and a follow up visit should be scheduled.

Due to the patient's recent diagnosis of ulcerative colitis, NSAIDS would be contraindicated, and have been found to contribute to gastrointestinal mucosal injury in patients with Crohn's disease and ulcerative colitis (Ananthakrishnan, Higuchi, Huang...Chan, 2012).

Along with opioids, adjuvants such as either Gabapentin, or Lyrica, which is an antagonist for the α2δ calcium channels (Buvanendran & Kroin, 2007) which will theoretically reduce postoperative pain and decrease opioid consumption (Shipton, 2011). The patient should continue taking her Cymbalta, which is a Serotonin/Norepinephrine reuptake inhibitor, and is also taken for neuropathy as well as an antidepressant. Steroids should be administered, at a tapered dose, which will help reduce the inflammation at the surgical site (Buvanendran & Kroin, 2007) and also help with the patient's ulcerative

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