The patient comes today for initial consultation for pain in the mid back and chest area. She was involved in a motor vehicle accident on 03/05/2012. She was going out of parking lot and was T-boned by another vehicle who lost control of the vehicle. She sustained major injuries to the left side of her body. She had fractured ribs and pelvis and had internal bleeding of the pelvis, pneumothorax, and chest tubes and was in intensive care for six weeks at Hospital. She developed four dissections in the arteries of her neck and carotids and had three strokes related to this. She was placed on Heparin and was subsequently on Coumadin for treatment. At this point, she has pain in the chest area where she had chest tubes and pain in the mid-back radiating into her left breast and sternum. Pain level is 10/10 without any pain medications. She has taken Tylenol with Codeine, which reduced her pain to a tolerable level. The pain is constant and is made worse with sitting and standing for long periods, and walking, bending, and lying down. Pain increased with work, sleep, lifting things, and recreational activities. She never had any pain issues prior to the motor vehicle accident. She denies any radiating pain down the extremities, numbness, or tingling. She also has pain in the pelvic area from the motor vehicle accident. She has had no treatment since she was released from the hospital.
Thoracic spine pain.
I recommend MRI of the thoracic spine to rule out any discogenic source of pain. She is having radicular type of thoracic pain to the left side. I also recommend CT scan of the chest due to the history of the rib fractures and the asymmetry seen on the left upper chest and scapular area. For the pain, I have ordered her Tylenol, No. 4 with Codeine one every four to six hours as needed for pain, #65 dispensed, no more than five per day. We will discontinue the oxycodone. We may consider time released medication for pain. She will begin physical therapy three times a week for four weeks. She will continue to follow-up with pulmonologist and primary medical doctor for management of her Coumadin. Urine drug toxicology and medication management agreement signed today. We will reevaluate the patient in 11-day period of time.