Percocet Case Summary

Based on the progress report dated 03/21/16, the patient reports that his low back pain tweaked again, after making the bed. He went to the emergency room last week and was provided with Toradol injection. He was told it was sciatica on the right leg. Now, it is in the center of the back and sacroiliac area. Current pain level is 8/10 with pain medications. He also reports that the left side of the back and leg is aggravated by sitting between 1 to 1.5 hours.

October is National Chiropractic Health Month. Why not celebrate it by getting some pain relief from Stroud Chiropractic? Many people believe that their chronic pain is something that they just have to live with. They live with back pain and neck pain for years without ever getting help. A report released by the National Institutes of Health concluded that around 100 million Americans are living with chronic pain as of 2015.

Patient denies any complications and new complaints associated with epidural steroid injection procedure; however, he states that approximately 5 days after the injection procedure, he felt a sharp shooting pain down the posterior aspect of both legs to the feet to the feet when lying on his back with his feet on the floor. Otherwise, he reports ongoing axial lower back pain and weakness with no significant radicular symptoms at this time. He reports only mild relief with use of over-the-counter ibuprofen. In addition, he reports of moderate pain located at the low back which describes as an aching, continuous and sharp pain. He rated his pain as 5/10 in severity at the time of visit. Pain radiates from the lower back and aggravated by bending, getting in and out of the car, lifting, reciprocating stairs, sitting, standing, turning, twisting and walking which is mildly alleviated by over-the-counter drugs and

In September of 1985, the plaintiff was rear ended. She suffered a sore neck and soreness in the right shoulder. In April of 1992, the plaintiff was in a motor vehicle accident suffering right leg and groin pain. An MRI was performed of the lumbar spine. The examination found no significant extra

IMPRESSION: History of chronic inflammatory demyelinating polyradiculoneuritis. The strength and sensation of his extremities continues to improve after this, with no recurrence of symptoms from this with weaning off of Imuran.

“OK, Team! We have a new patient in Room 3B who is being admitted with a progressive (gradual, advancing) decrease in mobility (movement) of his back and legs, and increase in pain located in the lumbosacral (lower back above the tailbone of the spine) area. The patient’s Primary Care Provider has sent along Computed Tomography scans (CT, a rotating x-ray emitter, detailed internal scanner) showing spinal stenosis (narrowing of the spine causing pressure on the nerves and spinal cord causing lower back pain.) and decrease of the normal lordosis (abnormal curvature lower spine, excessive inward curvature of the spine) in the thoracic vertebrae (upper and middle back). Lumbosacral

Per the medical report dated 09/29/16, patient complains of back pain, rated as 8/10, radiating to both lower extremities, worse with standing and walking.

12/01/15 follow-up visit identified lower back pain. Patient rates the pain as 7/10. The pain is characterized as burning. It radiates to the neck and upper back. Condition is associated with back pain and difficulty in ambulation. It is aggravated by bending over, lifting, prolonged sitting, prolonged standing and prolonged walking. Application of cold, application of heat, bending forward, medications and rest, relieve the pain. Medication side effects include nausea and vomiting. Patient’s primary care doctor stopped her oral medication due to nausea and vomiting; and her liver function tests were elevated. She does not know names, but the sleep aid and the oral medication for pain during the day were stopped. She tolerates the medications well. Patient shows no evidence of developing medication dependency. Patient does not feel the current medication she is taking adequately addressing her pain needs and would like to try a different medication. The level of sleep for the patient has decreased due to difficulty in failing asleep and due to

As per office notes dated 7/19/16, the patient complains of chronic low back pain at the localized curvature. There is radiating pain, which is increased since the fall. There is limited range of motion. Pain is exacerbated with walking, standing, and sitting. The patient had post lumbar surgery on August 2015. She states that the pain is progressively getting worse. Objective findings revealed pain in the lumbosacral region, more in the sacroiliac joint. Positive findings on fortin finger flexion test. There is limited lumbar flexion. The patient is subsequently diagnosed with lumbar sacral spondylosis; sacroiliac joint arthritis; and low back pain. Treatment plan includes diagnostic bilateral sacroiliac joint injection under ultrasound guidance. Then if the patient received good relief, then she is to proceed with sacroiliac joint radiofrequency ablation. A course of physical therapy would be appropriate since she has not had any physical therapy for increasing range of motion since her surgery 8/4/2015. Plan also includes weaning off opioid

The patient is a 59-year-old female who tells me in early June she was moving a rolling coffee table at home. She states she felt a twinge in her back and had pain that radiated down into her left leg. She does tell me she had similar symptoms years ago when she was working at a different job. She was diagnosed at that time with a herniated disk and did have steroid injections and was out of work for six months. She tells me since then symptoms have come and gone, but this was the worst case of it she has had for quite some time. She was given both Percocet as well as Valium in the Exeter Hospital Emergency Room and does tell me she took these and completed them. She currently is just taking ibuprofen. Overall, her symptoms are improving. She does tell me that she has noticed some

Every medication has a side effects and adverse effects. In this case, treatment choices fall into four categories: pharmacologic, nonpharmacologic, surgical and complementary (Sinuasas, 2012). In this patient’s situation, pharmacological treatment should begin with acetaminophen and gradually move up to nonsteroidal anti-inflammatory drugs. NSAID therapy is recommended as a first line therapy for minimum to mild arthritis. However, since the patient indicates GI distress to NSAID medication (Naprosyn), other NSAIDS medications may be utilized. According to Sinusas, “acetaminophen should be used as first-line therapy for mild osteoarthritis; NSAIDs as a class are superior to acetaminophen for treating osteoarthritis and patients taking NSAIDs should be cautioned about adverse effects, which may include gastrointestinal bleeding, renal dysfunction, and blood pressure elevation” (2012, p.

On examination of the lumbar spine there is pain on palpation over the lumbar paraspinals. Range of motion was full. Pain is worse on extension and rotation. Sensation is intact to light touch and pinprick in all dermatomes in the bilateral lower extremities.

They are not recommended for long-term use because long-term efficacy is unproven and there is a risk of dependence. Most guidelines limit use to 4 weeks. Additionally, ODG states that benzodiazepines are not recommended as muscle relaxants, due to rapid development of tolerance and dependence. There appears to be little benefit for the use of this class of drugs over nonbenzodiazepines for the treatment of spasm. The patient has chronic low back pain. 10/28/15 progress report described that the patient has pain with positive bilateral lumbar facet loading. The patient also complained of unprovoked occasional back spasms. There was little or no improvement in sleep and pain from Trazodone and Tramadol, so the patient had been prescribed Valium 5 mg, Mortin 600 mg, and Cyclobenzaprine. 10/28/15 progress report noted that the Valium was prescribed for insomnia. However, 11/26/15 note states an appeal to the denial of Valium and noted that it was being prescribed to address the muscle spams. The patient is already taking a muscle relaxant Cyclobenzaprine. As the guidelines do not support use of benzodiazepines for the treatment of muscle spasms; and there is a risk of significant dependence with long-term use, starting Valium is not supported. The request for Valium 5 mg#30 is not medically necessary and appropriate at this time. Recommend

Based on the medical report dated 09/21/16, the patient presents with right ankle pain, posteriorly. She states that she occasionally feels a pulling sensation medially after certain activities, such as when she climbs a ladder. She did receive an injection in her ankle with minimal relief. Symptoms are mildly alleviated by PT.

On examination the patient expressed pain with resisted plantar flexion and dorsal flexion and she wasn 't able to fully invert her left foot passively. However there was normal, active and passive movements of the right foot. Examination of the hip showed patient felt some ‘stiffness’ with active moments around the anterior thigh muscles but due to normal flexion/extension of the leg the osteopath ruled out any femoral or sciatic nerve damage from the injury.