A 54-year old Caucasian male, 5’10” tall and weighing 200 lbs, presents with chronic neck and shoulder pain. He has a muscular build and shares that he lifts weights with a professional trainer at least 3 times per week. He is unable to tolerate nonsteroidal anti-inflammatory drugs (NSAIDs) due to Barrett’s esophagus following an initial diagnosis of GERD 5-plus years ago and has a history of Helicobacter pylori negative gastrointestinal bleed. The patient also has a history of opioid use disorder (OUD), following acute pain management subsequent to a major motor vehicle accident 6 years prior that left him hospitalized for 4 months with fractures to the right hip, both wrists, and right ulna. He continues to suffer from residual bone pain from the accident and remains on chronic opioid therapy. He has a Patient Agreement with the practice and his compliance is monitored closely; he has not displayed any drug aberrancy for at least 3 years.
Other medical problems in this patient include general anxiety disorder and chronic and intermittent muscle spasms. He has post-traumatic stress disorder (PTSD) from the motor vehicle accident which impairs his sleep.
Overall, the patient’s medication regimen consists of:
- buprenorphine buccal film, 450 mcg Q12H for chronic pain
- hydrocodone/acetaminophen, 5/325 mg PO TID PRN pain
- alprazolam, 0.5mg PO BID each day, and 1 extra tablet daily only if needed for anxiety and/or muscle spasms
- quetiapine, 50 mg PO QHS for PTSD and sleep
- pantoprazole, 40 mg PO daily for Barrett’s esophagus and GERD
- venlafaxine XR, 225 mg PO QAM for pain and depression
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