Intercostal neuralgia

The patient is here for a follow-up visit with chronic neck pain. He states that since his last visit since he started taking Ambien, his neck pain and low back pain is almost completely resolved. He does not need to take any Vicodin. Since the last couple of months he is noticing more and more pain in the right upper quadrant of the abdomen and flank area and the pain gets excruciating and Vicodin does not seem to help things at all in that pain. He has had extensive workup by his medical doctor, but he feels the pain as previous 6-7/10. He seems a little frustrated with his pain. Otherwise, he is able to sleep at night with Ambien.

DIAGNOSES:
Right upper quadrant pain.
Intercostal neuralgia.
Thoracic radiculopathy.

RECOMMENDATIONS:
I will do a rib series and an MRI of the T spine to rule out above mentioned indication. I will discontinue Vicodin and Soma and prescribe Percocet one tablet 5/325 mg two to three times a day p.r.n. for pain. The patient will continue with Ambien 10 mg p.o. q.6h. p.r.n. for sleep. I will see the patient back in followup in a month and then decide the further course of treatment.

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