Patient with chronic pain needs followup after medicine changes from his last visit and to decide whether or not injection therapy at this point is still required.
The patient is a 62-year-old male being followed by myself. He has over a four-year history of lower back pain with progressive radiation down the posterior aspect of the thighs and into the calves as well as the soles of the feet. He states that the pain was sharp and lancinating with an ice pick type of a nature followed by a burning sensation and a deep ache. When initially seen, the patient's medications were adjusted and he was placed on an exercise regimen. He has been following up on a regular basis and with the adjustment in the medications as well as with the exercise …show more content…
He continues to show improvement, although he states that he has been having more back pain because of the absence of pain control medications. He states that he is ready to have his pain control medications re-initiated so that he will be once again pain-free. At this point in time, given the fact that his urinary retention should no longer be a problem, he may benefit from re-initiation of his doxepin at 25 mg per day, but it should not go any higher than 75 mg. He may also benefit from the initiation of gabapentin or pregabalin as well as baclofen and/or tizanidine. The reason for the former is that both of those medications are excellent with regard to somatic/nociceptive type pain and at the same time the way they would be helpful would be that they would modulate the central descending pathways and, therefore, diminish excitatory neural translator release. If there is consideration for anti-inflammatory medication, then turmeric and/or omega-3 could also be added. In the meantime, I have also given the patient four specific exercises that he is to perform on a regular basis independently. I did go over the exercises with him today and he is independent in performing them. I will see the patient again in another three or four months. At this point, however, I do not believe that there is any need to consider injection
The patient is a 62-year-old male being followed by myself. He has over a four-year history of lower back pain with progressive radiation down the posterior aspect of the thighs and into the calves as well as the soles of the feet. He states that the pain was sharp and lancinating with an ice pick type of a nature followed by a burning sensation and a deep ache. When initially seen, the patient's medications were adjusted and he was placed on an exercise regimen. He has been following up on a regular basis and with the adjustment in the medications as well as with the exercise …show more content…
He continues to show improvement, although he states that he has been having more back pain because of the absence of pain control medications. He states that he is ready to have his pain control medications re-initiated so that he will be once again pain-free. At this point in time, given the fact that his urinary retention should no longer be a problem, he may benefit from re-initiation of his doxepin at 25 mg per day, but it should not go any higher than 75 mg. He may also benefit from the initiation of gabapentin or pregabalin as well as baclofen and/or tizanidine. The reason for the former is that both of those medications are excellent with regard to somatic/nociceptive type pain and at the same time the way they would be helpful would be that they would modulate the central descending pathways and, therefore, diminish excitatory neural translator release. If there is consideration for anti-inflammatory medication, then turmeric and/or omega-3 could also be added. In the meantime, I have also given the patient four specific exercises that he is to perform on a regular basis independently. I did go over the exercises with him today and he is independent in performing them. I will see the patient again in another three or four months. At this point, however, I do not believe that there is any need to consider injection