Percocet Case Summary

Summary of Case Study: Bill is a 34 year old male who has recently been prescribed analgesic and muscle relaxant for his right hip pain. After three weeks of pain he is still experiencing symptoms. However, he is now experiencing stiffness and pain in his left hip as well.

She has lumbosacral tenderness greater on the left. Patient Opioid Misuse Index score is 0/6, indicating the patient is not a potential misuser of opioids. Graded Chronic Pain Scale score shows current pain level of 8/10, and worst and average pain for the last 30 days is 9/10. Pain interference with ability work or housework is 10/10, with recreational, social and family activities is 7/10 and with daily or general activities is 6/10, for the last 30 days. Current medications include Norco 10/325 four tablets a day.

He is currently complaining of recurrence of the pain. In regards to his left knee, he states that pain is much better compared to prior to surgery. His main complaint is weakness and difficulties going up and down the stairs. He had his recent physical therapy approved and he has done 2 sessions and he has additional 10 sessions left. Physical examination revealed healed surgical scar left knee.

He has an antalgic gait in lumbar flexion. Mr. Danes has reduced active range of motion of the lumbar spine, especially in 5 degrees of extension which reproduces his leg pain. The following orthopedic tests were positive: Minor 's’ sign, Kemp 's on the right, Yeoman 's’ bilateral, and Milgram

Knee and ankle jerks are 1+, bilaterally. There is weakness of the quadriceps, hamstrings as well as the flexors and extensors of the hips. Assessments include cervical sprain, lumbar sprain, constipation, left carpal tunnel syndrome, lumbar degenerative disc disease, and retrolisthesis at L5-S1. Patient was given prescription for Norco 5/325 mg one tablet twice daily for severe pain #60, Motrin 800 mg 1 tablet twice daily as needed for inflammation and pain #60 and Flexeril 7.5 mg 1 tablet at bedtime for muscle relaxation #30. Requested from the provider’s office copies of recent urine d rug screen and Controlled Substance Utilization Review and Evaluation System (CURES) reports; however, no reports were received prior to the submission of this request to PA.

It was noted that pain continues to be a major limitation for the patient. It was mentioned that better control over pain and spasticity since Baclofen pump placement, he continues to be highly motivated to continue physical therapies and his mood is buoyed by his meeting of physical

As per medical report dated 4/8/16, patient complains of having more pain lately. She notes that she had continued to maintain significant improvement to her low back and leg pain as a result of the bilateral L5-S1 transforaminal epidural injection on2/2/15. She also indicates that her low back and leg pain had continued to remain improved by more than 95%. She notes

Currently, he is prescribed Percocet with a maximum of eight tablets daily. He takes 1.5 tablets every six hours to help for his migraine headaches. His Percocet would start to decrease his pain after 30-45 minutes of ingestion, and the pain decreases for four hours. He mentioned that his pain never actually goes away. This medication was initiated three weeks ago.

He continues to complain of low back pain. He has intermittent numbness of the lateral aspect of the left leg to the lateral toes. He does have intermittent weakness of the left leg as well. He continues to take Norco 10/325 5 per day, Motrin 800 mg 3 times a day, and Neurontin 400 mg 2 times a day.

It was also noted that the office will give a new lap slip. It was also noted that the patient is scheduled for a repeat caudal epidural steroid injection. Physical examination revealed that the cervical spine has decreased range of motion; tenderness to palpation at the paraspinal muscle; spasm at the bilateral cervical trigger point, bilateral trapezius rigger point, and bilateral rhomboid trigger point. There is also bilateral tenderness to palpation of facet joints C5-C7, positive Spurling’s test, foraminal compression test. Physical examination of the lumbar spine revealed decreased range of motion on all planes; tenderness to palpation at the lumbar paraspinous area; tenderness to palpation over the lumbar spine; bilateral straight leg raise; bilateral knee extension weakness, bilateral lumbar radicular sign, and spasm noted.

I would encourage MP to try more conservative methods of pain control before having cortisone injections since the injection can actually cause more joint damage over time ("Osteoarthritis - mayo clinic," 2014). I would recommend using Acetaminophen 650mg orally every 4 hours not to exceed 4000 mg in 24 hours along with Naproxen 500 mg bid since Advil no longer seems to be working for him (Woo & Wynne, 2012). I would refer him to a physical and occupational therapist in order to develop an exercise program that will assist weight loss and muscle strengthen without placing improper stress on the joints. I would follow up with him in 1 week to see how he is progressing then again in 1

This week I have seen a very interesting case at the Vine Clinic. A 17-year-old female who came in with her mother had a chief complain of joint pain and a severe headache uncontrolled by Ibuprofen. She has recently seen in the ER for joint pain. I observed my preceptor conducted a thorough history and physical exam. She started joint pain on the right side of her knee and then the pain migrated to the left side of her body and affecting all the major joints.

The Pt had Left Total Knee Replacement (TKR) ON 06/03/2015, following immense pain due to degenerative joint disorder. Pt had been having the pain since little over 5 years, but since the past year it started being unbearable as per the patient. Past Medical History: Pt has a Past Medical History (PMH) of Degenerative Joint Disease (DJD), back pain, anxiety, depression, GERD and hypothyroidism.

The affected area was also warm to touch. On examination the patient expressed pain with resisted plantar flexion and dorsal flexion and she wasn 't able to fully invert her left foot passively. However there was normal, active and passive movements of the right foot. Examination of the hip showed patient felt some ‘stiffness’ with active moments around the anterior thigh muscles but due to normal flexion/extension of the leg the osteopath ruled out any femoral or sciatic nerve damage from the injury.

During assessment, she stated that she usually experiences pain intermittently on the left side of her body, as well as her lower back and that her hip feels dislocated. The patient was not sure of how to rate her pain on a scale with 1 being the lowest and 10 being the highest, however, she stated that the pain worsens with movement and the pain is not relieved whenever she receives her medication. The medications given to her are: panadine and voltaren. The patient also states that there are no associated factors with the pain. Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families.