Mr. Marino is a 39-year-old man who has been followed by your practice for the last several years and is managed for diagnoses of bipolar depression, adjustment disorder, and PTSD. He has chronic pain as the result of a serious accident while he was serving in Afghanistan. He was in a vehicle explosion and has a left below-the-knee amputation, has had multiple back surgeries for extraction of foreign bodies and debris, lost one kidney in the accident, and now lives in chronic pain. He is seen by pain management and is on a plan that includes TENS therapy, physical therapy, epidural steroids, and chronic opioid management.
How can you optimize pharmacologic management of his psychiatric diagnoses to contribute to pain control? Assume you are starting with a blank slate for his PTSD, bipolar depression and adjustment disorder. Write the prescriiption you will issue, keeping the presence of comorbid pain. List a brief rationale for each pharmacologic choice.