The complete tender point exam was performed and he is positive in 12 of the 18 classic tender points. He also has some induration over the right trapezius tender point that is more classic for the trigger points of a myofascial pain syndrome than the tender point of fibromyalgia. Other interesting historical…
On 11/15/2016, the claimant reported a return of symptoms and stated that she started having spasm while working. On 11/18/2016, the claimant complained of right sacroiliac joint pain and sacrum pain that was described as moderate and constant which was rated as 5/10. There was also mild-moderate and constant right hip pain that was rated as 4/10 as well as moderate and constant neck pain that was rated as 6/10. The neck pain was unchanged since the last visit while the pain in the right sacroiliac joint, sacrum, and right hip were getting better. Examination revealed that there was increased myospasms in the right paralumbar, right parathoracic, and right paracervical muscles.…
Over the course of his career, Dr. Timothy D Francis has published a number of papers on subjects that range from spinal subluxation in correlation with bilateral muscle syndrome to the divergent meridians and miasmatic nosodes. Dr. Francis has served as an associate editor of the Alternative Medicine Review since…
Two pt verifier confirmed. Pt c/o worsening abomen pain x1 year. He states that he has been seen in the clinic multiple times for the same issue. Pt states that he recently completed a CT scan and cyst was noted to his kidney. Howvever, he is very concern because he in the last several weeks he's had a decrease in appetitie, loss weight, and constant has mid gastrric pain.…
Introduction: Carpal Tunnel Syndrome (CTS) is one of the most well-known nerve entrapment syndromes. This occurs when the medial nerve is pressed at the wrist. As a result, this causes a tingling sensation and weakness in the wrist and hand. Patients who have CTS are probably suffering from Occupational Carpal Tunnel Syndrome. This is due to a combination of factors, increased pressure on the median nerve and tendons rather than the actual nerve itself.…
What is fibromyalgia syndrome? Fibromyalgia (known by the initials "FM") is a complex, chronic condition which causes generalized pain and deep exhaustion, and also a variety of other symptoms. As the name suggests, fibromyalgia primarily affects the soft tissues of the body.…
Regarding Gabapentin 100mg #30, CA MTUS Chronic Pain Medical Treatment Guidelines state that Gabapentin has been shown to be effective for the treatment of diabetic painful neuropathy and post-herpetic neuralgia and has been considered as a first-line treatment for neuropathic pain. The patient has chronic neuropathic lower back pain, which radiates down her right leg. Medical necessity of Gabapentin has been substantiated. Recommend certification. Regarding Hydrocodone 5/325mg #90…
Tender facet joints at C3 to C7 bilaterally with positive provocation test. There was decreased ROM at the cervical spine. Muscle strength was 4/5 and sensations to touch over the left medial and lateral aspect of the forearm were diminished. The exam of the back showed tenderness to palpation at L1 to S1. Tender facet joints at L1 to S1 bilaterally with positive provocation test.…
Regarding Norco 10/325 mg #60, CA MTUS Chronic Pain Medical Treatment Guidelines state that there should be documentation of the 4 A's (analgesic, activities of daily living, adverse side effects, and aberrant drug-seeking behaviors). Per ODG Guidelines, when considering on-going opioid management, several factors should be considered, including prescription from a single practitioner; lowest possible dose to improve pain; documentation of pain relief; functional status; appropriate medication use and side effects; documentation of misuse and continuing review of overall situation with regard to non-opioids means of pain control. The medication was within guidelines supported levels. However, there has been no documentation provided regarding…
An person normally experiences anguish, stiffness, swelling, and/or warmness about the joints. When harm is not an underlying rationale, the discomfort can attack one or more joints, which…
Treatment Guidelines For Complex Regional Pain Syndrome The paper will describe treatment recommendations for a 43-year-old white male diagnosed with Complex Regional Pain Syndrome (CRPS). The paper will have three different decision points, and at each decision point, the psychiatric mental health nurse practitioner (PMHNP) will have to choose one of the treatment options available and explain the rationale of each choice that was preferred. The paper will describe why starting with Amitriptyline is a better option than Savella or Neurontin. Next, the paper will explain why the PMHNP chose to continue therapy with Amitriptyline and continue towards reaching the daily dose of 200 mg per day instead of reducing the dose or adding other medications…
Trigger Point Injection Trigger points are areas where you have muscle pain. A trigger point injection is a shot given in the trigger point to relieve that pain. A trigger point might feel like a knot in your muscle. It hurts to press on a trigger point. Sometimes the pain spreads out (radiates) to other parts of the body.…
My favorite subject that we spoke about in class is when we learned about Osgood-Schlatter Disease because I have this disease. We learned in class that Osgood-Schlatter Disease is when muscles become too tight because of rapid growth in the epiphyseal plate. The epiphyseal plate is a growth plate that is only in children and adolescence. The epiphyseal plate is at the superior end of the tibia by the tibial tuberosity. My doctor told me that this disease effects when I am physically active, which is difficult because I regularly play tennis, an anaerobic activity.…
Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot). CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. CRPS is divided into two types: CRPS-I and CRPS-II. Individuals without a confirmed nerve injury are classified as having CRPS-I (previously known as reflex sympathetic dystrophy syndrome). CRPS-II (previously known as causalgia) is when there is an associated, confirmed nerve injury.…
Muscle cramps Toggle: English / Spanish Definition Muscle pain are when a muscular gets restricted (contracts) without you trying to stressed up it, and it does not relax. Pains may consist of all or part of one or more muscles. The most usually involved muscles are: Coming back of the reduced leg/calf Coming back of the higher leg (hamstrings) Front side of the higher leg (quadriceps)…