This is a 57-year-old female with 8/01/06 date of injury, due to a slip and fall.
Diagnosis: chronic pain syndrome primary OA-L ankle and foot, MDD, Single Episode and Generalized Anxiety disorder.
12/08/15 progress note by Mehtani documented that the claimant had been seeing Dr. Desai for a period of time. She has been on a complex medication regimen. The provider is trying to cut down the use of Klonopin and Ambien. The patient was told this was her last prescription. In the meantime, he will try her on Vistaril 25 mg 2-3 times a day for anxiety and panic attacks #90 and trazodone 50 mg at bedtime #30. She will stay on Geodon 80 mg at bedtime #30 and Lexapro 20 mg a day #30. The patient will be seen once a month for medication and psychotherapy. The patient needs ongoing psychiatric care. She remains totally disabled from employment.
A prior review from 12/16/15 indicated, a12/15/2015 2:56 PM Phone conversation with Dr. Mehtani. He stated that the current plan is to keep the patient on Ziprasidone, as this is effective to control the patient 's symptoms. However, the …show more content…
Additionally, pain specialists rarely, if ever, recommend Ambien for long-term use. While improved sleep was noted in this patient, chronic use of Ambien noted since 2011 has far exceeded the guideline recommendations. Moreover, Ambien can be addictive; it may impair function and memory more than opioid pain reliever; and it may increase pain and depression over the long-term. The provider indicated in the 12/08/15 progress note that he is trying to cut down the use of Klonopin and Ambien and the patient was told that this was her last prescription. The provider also mentioned in a phone conversation on 12/16/15 that zolpidem needed to be weaned and discontinued. Medical necessity of Ambien has not been substantiated. Recommend
Diagnosis: chronic pain syndrome primary OA-L ankle and foot, MDD, Single Episode and Generalized Anxiety disorder.
12/08/15 progress note by Mehtani documented that the claimant had been seeing Dr. Desai for a period of time. She has been on a complex medication regimen. The provider is trying to cut down the use of Klonopin and Ambien. The patient was told this was her last prescription. In the meantime, he will try her on Vistaril 25 mg 2-3 times a day for anxiety and panic attacks #90 and trazodone 50 mg at bedtime #30. She will stay on Geodon 80 mg at bedtime #30 and Lexapro 20 mg a day #30. The patient will be seen once a month for medication and psychotherapy. The patient needs ongoing psychiatric care. She remains totally disabled from employment.
A prior review from 12/16/15 indicated, a12/15/2015 2:56 PM Phone conversation with Dr. Mehtani. He stated that the current plan is to keep the patient on Ziprasidone, as this is effective to control the patient 's symptoms. However, the …show more content…
Additionally, pain specialists rarely, if ever, recommend Ambien for long-term use. While improved sleep was noted in this patient, chronic use of Ambien noted since 2011 has far exceeded the guideline recommendations. Moreover, Ambien can be addictive; it may impair function and memory more than opioid pain reliever; and it may increase pain and depression over the long-term. The provider indicated in the 12/08/15 progress note that he is trying to cut down the use of Klonopin and Ambien and the patient was told that this was her last prescription. The provider also mentioned in a phone conversation on 12/16/15 that zolpidem needed to be weaned and discontinued. Medical necessity of Ambien has not been substantiated. Recommend