This week's case is about a patient, Rick, a 36-year-old male with chronic back and neck pain. He works as a computer programmer, logging long hours in his office chair, which doubles as his gaming chair. He says that if he twists his neck or back the wrong direction, he experiences severe pains across his entire low back and up into his neck. He manages his pain with hydrocodone/apap, 4 tablets a day, along with daily cannabis use, which he says is helpful for pain, anxiety, and sleep. Lately his pain has been worse and he’s increased his dose to 6 tablets/day, so has now run out early and is requesting a refill.

This week's case is about a patient, Mary a 50 year old who presents with long standing knee pain for Xray proven moderate osteoarthritis. Mary is interested in trialing a steroid knee injection for her osteoarthritis and has trialed other interventions including OTC medications and lidocaine patches without significant relief. As her clinician you believe that prior to trialing knee injections, physical therapy, lifestyle changes and diclofenac cream may be important to trial, given her young age and potential harms.

This week's case is about a patient, Danielle, a 54-year-old female, with chronic lumbar radiculopathy taking long-term morphine. Her pain is manageable, but she occasionally requests early refills and denies non-medical drug use. Her urine drug screen is consistent with prescribed opioids only.

Mary is a 67-year-old woman with chronic pain, diabetic neuropathy, and depression, anxiety, and insomnia. She uses opioids, benzodiazepines, and other medications, and occasionally drinks alcohol to help with sleep.

Mary is a 67-year-old woman with chronic pain, diabetic neuropathy, and depression, anxiety, and insomnia. She uses opioids, benzodiazepines, and other medications, and occasionally drinks alcohol to help with sleep.

Mary is a 67-year-old woman with chronic pain, diabetic neuropathy, and depression, anxiety, and insomnia. She uses opioids, benzodiazepines, and other medications, and occasionally drinks alcohol to help with sleep.

This week’s case explores a 35-year-old female with a history of chronic insomnia, anxiety, ADHD, and bipolar disorder. Her current regimen includes PRN alprazolam and twice-daily dextroamphetamine/amphetamine 30mg.

This week’s case explores a 64 year old male with bilateral above-knee amputations and chronic pain transitioned to this practice in 2018 while on a high-dose regimen exceeding 400 MME. His treatment included OxyContin, oxycodone IR, and alprazolam.