Chronic upper and lower extremity radicular pain.

The patient presents today for monthly medication management follow-up visit. She currently has an intrathecal pump in situ of morphine, which is managed by Dr. at his Office. She comes for chronic high dose opioid management in conjunction with her morphine pump.

Upon questioning, she is unable to give me her medication list today of the all the medicines that she is currently on. Our office is managing oxycodone both long-acting and short-acting in addition to Valium for spasms.

She states that the intrathecal pump was placed initially six years ago that she last had it filled approximately two weeks ago. She states that the pump needs to be changed soon as it only has a six-year shelf life.

I was able to obtain her intrathecal pump printout today as her pump was increased by 15% at Dr. office by the nurse.

Current medications include OxyContin 60 mg b.i.d., oxycodone 30 mg maximum four per day, and Valium 5 mg q.8h.

IMPRESSION:
1. Intrathecal pump in situ; morphine of 25 mg per cc concentration with the current dosing at approximately 11 mg per day (the value is illegible on the sheets she gives me today). The pump is 20 cc volume unit from Medtronic and is a SynchroMed II pump.
2. Status post three anterior cervical neck surgeries; levels unknown.
3. Status post two posterior lumbar surgeries; level unknown.
4. Chronic intractable pain.
5. Osteoarthritis of the right knee with history of viscosupplementation injections with this office.
6. Chronic upper and lower extremity radicular pain.
7. Currently on disability/Medicare; the patient was a registered nurse.

PLAN:
I did refill her oxycodone 30 mg q.6h., #120 and OxyContin 60 mg b.i.d. in addition of Valium 5 mg q.8h., #90. These are one-month prescriptions. I recommended that she make a follow-up visit with Dr. specifically to see if there should be a change in medication for her pump. I told her that we could not manage intrathecal pump medications here at this office and that it was recommended that she pursue treatment at a facility where she can receive both her oral medications and intrathecal medications concomitantly. She voiced understanding.

We will see her back in one month’s time for follow-up. Of note, she has undergone to requisite urine drug testing here in this office within this calendar year.

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