Low Back Pain Case Studies

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This is a 47-year-old male with a 2/1/2007 date of injury, who injured his low back from lifting a large bucket of cut grass.

1. Left SI radicular symptoms. Lumbar discogenic pain with high-intensity zone at L5-S1 per MRI April 2007. X-ray showed 4-mm retrolisthesis at L5-S 1.
2. EMG/NCV studies consistent with peripheral motor and sensory neuropathies, from October 2008

12/15/15 Progress Report described that the patient has ongoing low back pain. He was last seen on 10/28/15. The patient stated that his current medication regimen has been helpful. He rated the pain 9/10-scale level, which is brought down to 6/10-scale level with the medications. The medications allow him to do his ADL. The patient also stated the Norco works
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This is a chronic pain patient and has been on Norco for an extended period of time.12/15/15 progress report described that that patient was on Butrans patch in the past and switched to Norco due to side effects of Butrans. The medications bring his pain to 6/10-scale level from 9/10-scale level. However, there remains little specific information regarding monitoring for diversion, dosage adjustments, functional improvement, attempts to wean and taper, endpoints of treatment and continued efficacy and compliance. Furthermore, there were no UDS or CURES reports available for review. A prior review from 05/08/15 denied Norco due to lack of documentation of continued efficacy, proper use of the medication, compliance; and absence of side effects and aberrant behaviors. The pharmacy list provided for review revealed that the last Butrans patch was approved on 09/11/15 and last Norco was approved on 05/02/15, however, the latest progress report contradicts this report. Current treatment regiment of the patient is unclear from the reports. Medical necessity of Norco 10/325 mg #60 has not been substantiated. Recommend non-certification. Non-certification here does not imply abrupt cessation for a patient who may be at risk for withdrawal symptoms. Should the missing criteria necessary to support the medical necessity of this request remain unavailable, discontinuance should include a tapering prior to discontinuing to avoid withdrawal
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