Chronic anal/rectal pain

The patient comes in today for a follow-up visit. He continues to have chronic intractable rectal pain related to chronic perirectal abscess. He brought me records from the Cleveland Clinic where he was seen by Dr.. Dr. saw the patient in March 2011. The patient had a pelvic pouch surgery in 1981 due to ulcerative colitis. It was complicated by development of chronic pelvic abscess and pouch-perineal fistula, which then resulted in severe stricture of his ileal pouch-anal anastomosis. The patient has developed stricture by using calves to intubate and drain his pouch over the years. He has purulent drainage constantly, which he has to attend to. He is not a candidate for a redo of the pouch procedure and another option would be a permanent ileostomy. He is currently taking the Percocet, which is helping with his pain. I have given him some Nucynta to try with the Percocet but the patient tried just taking the Nucynta alone by itself without the Percocet and did not find much relief. So, he stopped taking the Nucynta and is just going with Percocet.

338.9 Chronic pain syndrome.
Chronic anal/rectal pain.

We will continue Percocet 10/325 mg one every four hours as needed for pain, #120 dispensed. I reeducated the patient about the Nucynta. I want him to try to take the Nucynta twice a day and using the Percocet in between only as needed for breakthrough pain and see if he is able to cut down on Percocet with using the Nucynta. I filled out paperwork for disability as he is unable to work because of the pain as well as time involvement in taking care of the pouch-perineal fistula. I will see the patient back in 28-day period of time for reevaluation if he has any problem in the interim.


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