Management Of Multiple Sclerosis: Comprehensive Assessment, Intervention And Pain Management

Comprehensive Assessment of MS

Assessment Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	Rationale
Physical	Physical assessment is necessary to understand the extent of the disease. MS is associated with disruption of the nerve signaling from the central nervous system and causes physical complications like fatigue, poor muscular coordination, slurred speech and balance disturbances that can only be assessed by physical examination (Sandroff et al., 2014).
Environmental Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	Andrea has become susceptible to slips and falls due to her gait disturbances and hence it is necessary to check whether the home environment is safe for her both mentally and physically.
Physiological	A physiological assessment helps in understanding the clinical manifestation of the condition, in this case, impaired motor skills, gait disturbances and problems in motor skills (Sandroff et al., 2014).
Psychological	MS is a disease of the CNS and can cause impaired cognition. Furthermore her physical complexities and incontinence has diminished her self-confidence and she has also felt that her marriage might be at stake (Beer et al., 2012). She might have been suffering from depression due to her inability to carry out her daily chores or assist her husband or her children.  Hence it is necessary to understand the psychological condition of Andrea.

Assessment	Intervention	Evaluation
1. Physical (provision of mobility supports)	Provision of aids for the personal care and protection and personal mobility, hearing aids, personal alarm system, provision of wheelchairs, practice of strengthening exercises (Hayes et al., 2017).	By taking feedback from the patient and the family or by checking the number of fall rates with the previous records and the increased mobility of the patient.
2. Environmental (Environmental modifications for preventing falls )	Environmental modifications such as provision of the hip protectors and the adaptors, effective lightening, provision of handrails where appropriate, shoes with non-slip soles.	Patient feedback and periodic risk assessment can evaluate the outcome measures.
3. Physiological (Physical therapy)	Andrea should be trained with balance challenging exercises, walking exercises, strength training (Sherrington & Tiedemann, 2015).  Exercise should aim to reduce the base of the support, move the center of gravity and reduce the need for the upper limb support.	The patient will feel relaxed after the sessions, would have less muscular spasms, increased gait and over a month should exhibit some improvement.
4. Psychological (Mental and spiritual support)	Psychoeducation, Cognitive-behavioral interventions and mindfulness based interventions can be helpful in treating depression in Andrea (San Jose et al., 2016, Feinstein et al., 2016).	With this interventions Andrea should be fully conscious of her body and her mind and would help her to change her perceptions.

1. Physical: It is evident from the case study that Daniel is a plumber and has his own business. Furthermore due to the inability of Daniel to take up the household responsibilities naturally generates pressure upon him as he has to manage both the house and his work, which may affect his physical wellbeing.
2. Psychological: Daniel’s worry for Andrea and the combined pressure of the household and children can act as the psychological burden.
3. Financial: It is evident from the case study that both Andrea and Daniel were financially independent and were long been contributing equally to the family. Andrea’s inability to continue with the job due to her increasing physical complications has rendered Daniel to be the only earning member, who has to bear both the cost of the treatment as well as maintain the household.  

1. Physical:

In order to assist Daniel in the household work as well as providing care to Andrea, a care worker can be recommended. Daniel can also be assisted with a proper meal plan or a therapist in case he does not get time for self-care.

1. Psychological:

Daniel can be counseled and recommended for community engagement as social interaction would relieve his stress and in case of severe anxiety a psychotherapist can be recommended (Asano & Finlayson, 2014).  

1. Financial: Daniel can be educated about the various health care schemes and financial grants and can be introduced to community groups or organizations that can provide him with financial support for the treatment, home care and equipment.

Question 5:

Type of pain	Cause of pain
1. Trigeminal neuralgia	This is a kind of sharp, electric, facial pain that is caused due to the inflammation of one of fifth cranial nerve and causes a jolt of excruciating pain (Solaro et al., 2013). In can occur due to simple brushing of teeth, putting up the make-up, chewing or simple touching of face.
2. Musculoskeletal (nociceptive) pain	This is mainly caused due to the damage to the tendons, muscles, ligaments and the soft tissues. For example and the back and the neck pain occurring due to changes in the sitting posture. This type of pain causes back stiffness and often periodic aching.
3. Burning limb pain	This is another kind of neuropathic pain that causes burning or tingling sensation in the legs and in many parts of the body. The parts of the body might become sensitive to touch as demyelination can modify the sensory signaling to the brain and the spinal cord (Solaro et al., 2013).
4. Multiple sclerosis hug (tight feeling)	This is a girdling pain around the chest or torso, a feeling of tightness or pressure around the chest causing it difficulty to breath. This pain is mainly caused due to the intercostal muscular spams and intermittent spasms in the surrounding tissues.

Non-pharmaceutical Intervention	Justification
1. Exercise and yoga	Exercise and yoga can help in improving the mental and the emotional health, bladder control, vision and the capability to bear the pain (Dalgas & Stenager, 2012). It not only helps improving gait but also improves the blood circulation.
2. Acupuncture	Acupuncture adjusts the vital flow of the energy and the blood along the body restoring balance of energies. It helps in clearing away the toxicities of the body. Endogenous opioid peptides (EOPs) were regarded as the major candidates for a role in acupuncture’s mode of action, as electro-acupuncture analgesia (EAA) is antagonized by the opioid receptor antagonist Kawakita & Okada, 2014).
3. Therapeutic ultrasound	Therapeutic ultrasound has been found to have anti-inflammatory and pain relieving benefits in patients with MS (Sánchez et al., 2013). It can act as  good analgesic for the nodule management in MS.
4. Magnet therapy	Static magnet are placed in the acupuncture points to relive the pain. Increased peripheral blood flow has been proposed as the mechanism of action which is associated with alterations in the fibroblast concentration at the wound sites. Limited evidences have also proven the blockage of the action potentials that transmits the pain signals.

Drug	Class of Drug	Indication
Baclofen	Antispasticity agents (muscle relaxant)	It helps to inhibit the reflexes of the spinal cord and thus helps in reducing the spasticity Otero-(Romero et al., 2016). As per the literature it is found to be acting as the agonist at the GABA receptor.
Diazepam	Benzodiazepines	Is used to treat spastic muscular paresis and is administered orally. It does so by the enhancement of the activity of the inhibitory neurotransmitter in the Central nervous system.
Gabapentin	Anticonvulsant	Used as an adjunctive therapy for partial seizures in patients multiple sclerosis and is taken orally Gabapentin resembles the neurotransmitter gamma aminobutyric acid (GABA) structurally and might be related to the mode of action -(Romero et al., 2016).

Question 8:

1. It is evident from the case study that Andrea has been suffering from a progressive neurodegenerative disorder and is so strained with her own physical and mental burden that she cannot take care of her children (Razaz et al., 2013). Lack of love and care can have psychological effect in kids. Hence a child counselor can be referred to.

1. Children with parents having cognitive or physical disabilities are likely to have restricted growth due to lack of care (Pakenham et al., 2012). A child care community service can be contacted who would appoint specific community nurses or caregivers or would arrange for periodic visits by a GP for a periodic assessment of the child’s health and mental status.

The prognosis of the Relapsing-remitting MS (RRMS) mainly depends upon the severity of the condition (Goldenberg, 2012). This neuro-degerative disease has brought about several health complications in Andrea. There is normally no predictable pattern for the RRMS, but mainly occurs due to demyelination. The immune system attacks the myelin sheath and causes muscular spasms, tingling sensation and numbness in the body. MS normally have two attacks in the first two years after the onset. Early relapses can cause quick progression of the disease.  As the disease progresses patients are subjected to face mobility issues, spasticity, optic disturbances, incontinence and muscular spasms. However RRMS if left untreated can worsen the suffering of the patient.

References

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Asano, M., & Finlayson, M. L. (2014). Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Multiple sclerosis international, 2014.

Beer, S., Khan, F., & Kesselring, J. (2012). Rehabilitation interventions in multiple sclerosis: an overview. Journal of neurology, 259(9), 1994-2008.

Dalgas, U., & Stenager, E. (2012). Exercise and disease progression in multiple sclerosis: can exercise slow down the progression of multiple sclerosis?. Therapeutic advances in neurological disorders, 5(2), 81-95.

Feinstein, A., Magalhaes, S., Richard, J. F., Audet, B., & Moore, C. (2014). The link between multiple sclerosis and depression. Nature Reviews Neurology, 10(9), 507.

Goldenberg, M. M. (2012). Multiple sclerosis review. Pharmacy and Therapeutics, 37(3), 175.

Hayes, S., Kennedy, C., Galvin, R., Finlayson, M., McGuigan, C., Walsh, C. D., & Coote, S. (2017). Interventions for preventing falls in people with multiple sclerosis.[Protocol].

Kawakita, K., & Okada, K. (2014). Acupuncture therapy: mechanism of action, efficacy, and safety: a potential intervention for psychogenic disorders? Biopsychosocial Medicine, 8, 4. https://doi.org/10.1186/1751-0759-8-4

Montano, N., Papacci, F., Cioni, B., Di Bonaventura, R., & Meglio, M. (2013). What is the best treatment of drug-resistant trigeminal neuralgia in patients affected by multiple sclerosis? A literature analysis of surgical procedures. Clinical neurology and neurosurgery, 115(5), 567-572.

Otero-Romero, S., Sastre-Garriga, J., Comi, G., Hartung, H. P., Soelberg Sørensen, P., Thompson, A. J., … & Montalban, X. (2016). Pharmacological management of spasticity in multiple sclerosis: systematic review and consensus paper. Multiple Sclerosis Journal, 22(11), 1386-1396.

Pakenham, K. I., Tilling, J., & Cretchley, J. (2012). Parenting difficulties and resources: The perspectives of parents with multiple sclerosis and their partners. Rehabilitation Psychology, 57(1), 52.

Razaz, N., Nourian, R., Marrie, R. A., Boyce, W. T., & Tremlett, H. (2014). Children and adolescents adjustment to parental multiple sclerosis: a systematic review. BMC neurology, 14(1), 107.

San Jose, A. M., Oreja-Guevara, C., Lorenzo, S. C., Notario, L. C., Vega, B. R., & Pérez, C. B. (2016). Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: The contribution of mindfulness-based interventions. Neurología (English Edition), 31(2), 113-120.

Sánchez, A. G., Andrade, E. L., Marsal, J. V., Tauste, L. A., Mingot, C. G., Monge, J. L., … & Moncusí, S. P. (2017). A study to evaluate the effect of ultrasound treatment on nodules in multiple sclerosis patients. International Journal of Neuroscience, 127(5), 404-411.

Sandroff, B. M., Klaren, R. E., Pilutti, L. A., Dlugonski, D., Benedict, R. H., & Motl, R. W. (2014). Randomized controlled trial of physical activity, cognition, and walking in multiple sclerosis. Journal of neurology, 261(2), 363-372.

Sherrington, C., & Tiedemann, A. (2015). Physiotherapy in the prevention of falls in older people. Journal of physiotherapy, 61(2), 54-60.

Solaro, C., Trabucco, E., & Uccelli, M. M. (2013). Pain and multiple sclerosis: pathophysiology and treatment. Current neurology and neuroscience reports, 13(1), 320.