Osteoarthritis of the knees

The patient comes in today for a follow-up visit. She continues to have bilateral knee pain as well as pain in the shoulders and wrists. She has rheumatoid arthritis. She is continuing with current pain medication as it is keeping the pain at tolerable level. Pain level is 5-6/10 on a visual analog scale with medications and 9-10/10 without medications. The Orthovisc series did help somewhat with her knee pain. She denies any memory impairment, oversedation, constipation, nausea, itching, high or buzz on the medications. She is having a lot of pain in her right wrist and thumb area. Knee braces are helping with the pain in her knees and she would like a brace for her wrist if possible. She tried to use an ACE bandage and did get some improvement with back. She is alert and functional with better quality of life since coming to the Pain Center. She is resting fairly well at night. She denies any changes in her past medical history, past surgical history, medications history, allergies, family history, social history, or review of systems.

DIAGNOSES:
Rheumatoid arthritis.
Osteoarthritis of the left shoulder.
Osteoarthritis of the knees.
Osteoarthritis of the wrists and hands.

RECOMMENDATIONS:
I discussed risks, benefits, and alternatives to the P-stim procedure. We will recommend that we give this a try for treatment of her chronic pain. She is agreeable to proceed. We will continue Roxicodone 15 mg one q.6h. as needed for pain, #120 dispensed. She will continue with the Mobic. I have given order for wrist brace for right upper extremity. We will see her back in one-month period of time for renewal of her medications. If she has any problems in the interim, she will contact the office.

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