When a patient's chronic pain gets worse.

摘要

One of my patients is a 55-year-old man in good health except for chronic low back pain. His back pain was stable, with intermittent flares that were controlled by receiving acetaminophen/hydrocodone (Xodol) tablets. However, in the past several months his focal back pain has intensified, absent any radicular symptoms, leading him to accelerate his use of pain medication. With his complaints of daily, severe pain, I recently had the patient sign a pain agreement that includes a stipulation about no early prescription refills. Because he has no red flags for prescription drug abuse, I prescribed methadone, 5 mg three times daily, and acetaminophen/hydrocodone for "breakthrough" pain. He now comes to my clinic frustrated and upset, having run out of both pain medications early and asking for refills. I have always had a good working relationship with him and he trusts my professional expertise. When I ask him how he has been spending his time, he replies, "In bed, it just hurts too much and I don't feel like I'll ever be healthy again." I am not exactly sure what to do next to help this patient.