Scenario: A homeless gentleman who appears intoxicated and in pain….

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Scenario: A homeless gentleman who appears intoxicated and in pain. He is a 68-year-old Caucasian, who is known to the clinic and often presents weekly complaints of generalized pain to his feet and knees bilaterally. He is usually given fluids and over-the-counter ibuprofen stocked by the clinic. He is then sent to the local homeless shelter after an hour or so. Today, he is refusing the ibuprofen, while complaining of more pain than usual. He wants stronger pain medication. The team suspects chronic gout and have ordered several diagnostic tests to confirm the diagnosis.

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  1. Pathophysiology: Explain the pathophysiology of chronic gout. Include the following in your response:
    1. What are the specific causes and risk factors for the disease?
    2. What are the common types of pain experienced by an individual with this disease?
    3. Is the pain likely to be acute or chronic?
  2. Pharmacotherapeutics: Analyze potential pharmacotherapeutic options, including a first-line drug therapy option and at least one second-line or third-line option, for the individual in the case. Include the following in your response:
    1. Would you recommend a controlled substance for pain management in this situation? Please explain.
    2. What are some alternative and complementary treatment options you would recommend in this situation?
  3. Legal and Ethical Implications: Describe the legal and ethical implications surrounding the use of controlled substances in this situation. Consider the following in your response:
    • The age of the individual in the case
    • Specific risks for substance abuse, including tolerance, ethnicity, and socioeconomic considerations, for the individual in the case
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