Background
A 45-year old male sustained a mild traumatic brain injury (with no loss of consciousness) during the course of his employment, resulting in post-concussive syndrome, cervicogenic headaches, neck pain, radiculitis, sleep disturbance, depression, and disequilibrium. In the years following the injury, the patient’s condition continued to deteriorate. Complaints included cognitive deficits, short-term memory loss, nightmares, and problems with processing. Psychiatric conditions included anxiety, hallucinations, and eventually, the inability to function independently. In addition to these conditions, the patient also began experiencing severe constipation alternating with diarrhea and urinary incontinence.

The patient was treated by numerous specialists, none of which could explain the patient’s rapid deterioration, given the nature of his injury. Despite taking approximately fourteen medications to treat his various conditions, the patient reported no improvement in symptoms.

Intervention
A comprehensive review of the claimant’s medical records and prescription history by the clinical pharmacist revealed polypharmacy that was likely resulting in some of the patient’s complaints. The review also revealed medication use that was inappropriate for long-term use, as well as medication use that was likely unrelated to the injury.

Results
Recommendations made by the clinical pharmacist included the addition of an adjunct medication for more adequate treatment of the patient’s neuropathic pain symptoms and cervicogenic headaches. Therapy recommendations also reduced the number of medications from fourteen to four, by either discontinuing the medication altogether or by discontinuing compensation for the medication (if unrelated to the injury).

Potential Savings
Current annual prescription costs: $51,948
Annual prescription costs following therapy modifications: $29,127
Potential savings: $22,821/year