A 52-year-old women was referred to our unit with severe pain in the right side of the chest, having been kicked in the right flank by a horse 10 years earlier. At the time she sustained fractures to the right 10th, 11th, and 12th ribs and briefly required hospitalization. The pain was sharp and stabbing in nature. Standard oral analgesia including nonsteroidal anti-inflammatory drugs was ineffective. She obtained little relief from opiates and was reluctant to take them long term. Some transient analgesia was obtained through epidurals and intercostal nerve blocks. She had been managed with gabapentin mg twice daily and amitriptyline 25 mg daily long term.
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