Left groin pain into his left testicle starting from around his low back.

The patient is an 87-year-old white male who presents to our office by himself with the chief complaint of left groin pain into his left testicle starting from around his low back. The patient’s history is significant for a trilevel L3 through L5 lumbar laminectomy in January 10, 2012 for reported spinal stenosis and neurogenic claudication. The surgeon at that time reported that the patient had some groin pain postoperatively and reported that has been present for a long time. So, I am unaware if this was present before or after surgery, however, the patient today claims that was only present subsequent to surgery and additionally claims that surgery did not help his symptoms. The patient complains currently of 8/10 back pain but predominantly aching pain in his left groin and bilateral pins and needles in his bilateral calves and feet. He claims that it is present all the time constant and he states that the medication makes it better, particularly naproxen although he was not aware of that over-the-counter dose that he takes. The patient states the symptoms are the same since onset and he has no other pain syndrome. He states he had one surgery for cancer in the past unknown location and this L3 to L5 lumbar laminectomy in 2012.

ALLERGIES:
He has seasonal hay fever.

SOCIAL HISTORY:
The patient is going to be seeing his cardiologist soon because he is concerned that his blood pressure lately has been running too low. The patient does not drink excessively socially. He rarely smokes cigarettes and does not use recreational drugs. He is retired, a widower and he does have children. His level of education is unknown.

ASSESSMENT:
This is an 87-year-old white male who is status post spinal surgery at L3 through L5 laminectomy with failed back surgery syndrome. He has tried epidural injections in the past actually prior to surgery, which were of no help. Additionally, he has tried acupuncture in the past which is of no help. The patient has pain that is responsive to naproxen over-the-counter. The patient has hypertension.

PLAN:
1. To do a nerve conduction study/EMG to assess nerve function.
2. We change him from naproxen to Naprosyn 500 mg p.o. b.i.d. prescription sent.
3. I will have him come back to our office in two to four weeks for reevaluation. The patient may be a candidate for other medications such as anti-seizures medicines like Neurontin at night. Given the fact that he is 87 years old and uninterested in injection therapy, I am going to try light medication management possibly a TENS unit as well in the future and other adjuvant medications.

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