Age: 43
Sex: Male
History: Bilateral sciatic pain worse on the left side.
1979-87: Four spinal operations -- disc surgeries x 2, laminectomies x 2.
Examination: CT/myelogram and MRI -- Epidural and perineural fibrosis with arachnoiditis.
Pain Procedures Performed:
- Trial of spinal cord implant -- Failed.
- May, 1988 -- Deep brain implant in right paraventricular grey -- Good result.
- In 1992 -- Developed severe retro-orbital headaches which was considered to be sequelae to his deep brain stimulating program.
- In 1995 -- Recurrence of right sciatic pain. Extruded disc L4-5 was found and excised -- No benefit. Deep brain electrodes now not controlling pain.
- November 1996, -- Intrathecal Morphine pump. Initially he did well on 1.8mg/day. Gradual dose increase to 4.9mg o.d.
- Side effects -- cold sweats, hallucinations, loss of sexual potency, and myoclonic jerks, of the legs. To control side effects, dose gradually reduced to 1.946mg o.d. Pain control not ideal.
- 1999 -- Neck and left upper limb pain. C5-6 surgery -- No benefit.
- Presently, continues to complain of headaches, neck and bilateral upper limb pain; back pain with bilateral sciatica, depression and suicidal thoughts.
Present Medications:
- Morphine -- 1.946mg/day
- Naprosyn -- 750mg SR b.i.d.
- Trazedone -- 50mg o.d. h.s.
- Hydroxyzine -- 25mg h.s
- Wellbutrin -- 150mg SR b.i.d.
- Epival -- 250mg a.m and 500mg h.s.
- Testosterone -- every 2 weeks
QUESTION:
- ? Management.
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