The patient is a 45-year-old male, who works in auto salvage yard for approximately 35 years. Since February 2011, he started to experience pain in multiple joints. He has been seen by multiple practitioners and undergone multiple blood work as well as injections with no relief of this pain. He stated that the only medication that has helped him is oxycodone 30 mg. He has tried gabapentin, Naprelan, Lyrica made him stink, according to him. He also tried hydrocodone, Vicodin, tramadol and Percocet which only messed up his stomach. He has been referred here for further recommendations in term of his treatment. He describes his pain as follows: Triggering events: Unknown. Duration: Constant. Quality of intensity: 10/10. Radiation: Pain is localized to the major joints including bilateral wrist and hands, shoulders, hips, low back, ankles and knees. Aggravating factors: Inactivity. Alleviating factors: Physical activity. He claims that when he moves around, the pain feels better. Associated factors: Numbness and achiness. He also claims swelling of his joints.
2. Myofascial pain.
3. Chronic pain syndrome.
1. The patient has been evaluated by a rheumatologist who is referring him to this office for further recommendations. The patient has responded very well to plain oxycodone 30 mg which is interesting since he claims that Percocet made him sick. Percocet has the same ingredient as oxycodone with exception of the Tylenol. My recommendation will be to start the patient on long-acting opioid such as OxyContin 15 mg twice a day. He may use oxycodone 15 mg for breakthrough pain to take no more than two tablets a day as needed. He will need to undergo urine toxicology and sign an opioid contract. Please do no hesitate to contact this office if you have any questions regarding these recommendations.
2. The patient will return to this office as needed.