Celebrex Case

Review of the medical record indicates that he had a MVA in 1977 with C4-5 injury that resulted in him been a Quadriplegic. Due to his bedbound and immobility status he has had multiple pressure ulcers over the years that have resulted in hospital admission and rehab stays. Other medical history include, HTN, hyperlipidemia, Sacral pressure ulcer, Right hip pressure ulcer, Constipation, depression. Bilateral arm contractures, bladder cancer, prostate cancer, urostomy and colostomy, aspiration pneumonia, neuropathy and MRSA.

02/12/16 Progress Report noted tat the patient is s/p left calcaneus fixation on 09/24/15. His current pain level ranges from 3/10 to 7/10 with standing up. There is sharp pain with stiffness and welling. Medication: Albuterol and Symbicort. Assessment/Plan: Gastrocnemius equinus, left and post-traumatic arthritis of the left lower leg. Surgery paperwork complete and the patient will follow-up after the surgery.

Although she finds it mildly beneficial, she complained of intense gastric pain while taking ibuprofen. Heather is wary of supplementing with any form of acetaminophen as she felt “loopy,” at one instance which she did not attribute to any other underlying cause (i.e. fever, medication). Heather also has an aversion to opiates, as she does not tolerate the euphoria and confusion while being on them. The option of bupivicaine +/- corticosteroid was presented to treat her SI join pain and to produce a NSAID sparing effect. However, she is afraid of needles therefore this option was not pursued. Rather a trial of Tramadol immediate release, at a dose of 25-50 mg PO at bedtime was provided to Heather. Her SI joint pain was reduced by 30% (9/10 to 6/10) within 30 minutes of starting Tramadol, without any noticeable side effects. There was no effect on her chronic daily headache pain. She started taking tramadol immediate release around the clock, and wore off after 4 hours. Therefore a prescription for Zytram XL (Tramadol CR) was provided to decrease her baseline pain and address end of dose pain. In addition to she was provided an additional repeat of immediate release tramadol for breakthrough pain. Lastly she discontinued use of ibuprofen as her pain relief from Tramadol was

This is a 51-year-old male with a 1/21/2014 date of injury. A specific mechanism of injury has not been described.

It can be administered alone or part of a multi-disciplinary approach in relieving symptoms. It delivers pain-relieving medication directly to the source of pain in musculoskeletal pain conditions and their effects are often immediate and long lasting. They are often used to reduce opioid side effects or gain better analgesic efficacy. However, serious complications have been reported in the literature. The Closed Claims Project Database has reported 284 chronic pain management claims were reported between 1970 and 2000; 96% of the claims were related to interventional pain management techniques (10). Seventy-eight percent of these were related to nerve blocks and injections. Paraplegia or quadriplegia, epidural abscess, chemical injury from spinal cord injections, epidural hematoma, even more alarming death and brain damage were some of the reported complications; most commonly reported was pneumothorax and spinal cord nerve injury

In severe cases, your doctor may prescribe opiates such Codeine, Norco, Tramadol, Oxycodone, or Percocet – this should be used at the lowest dose and for the least amount of time possible

10/22/15 Pain management report by Dr. Saidov reported the patient has knee pain. The pain radiates up and down the left leg. The patient describes the pain as burning, aching and dull. The patient reports that the pain is 9/10-scale level on her worst day and 3/10-scale level on her best day. Bending forward, sitting, standing, and walking aggravate the pain. Medications relieve the pain. She has been previously treated with pain medications and PT. The PT was ineffective in controlling the pain. Tramadol was effective. The patient reports no side effects to the medications and states that her functional status improves and her pain is controlled with the medication. The patient is afraid to proceed with the SCS trial secondary to the fear of getting RSD in her spine. The patient admits having sleeping problems. Exam of the left lower extremity revealed decreased temperature in the left knee. There were parasthesias and signs of allodynia in the left leg. Knee stability was decreased on maneuvers and there was severe restricted ROM in all planes. Treatment plan included medication refill for gabapentin, tramadol, clonidine, lidocaine topical and pamelor oral. Follow-up in 1 month.

This is a 55-year-old female with a 3/25/2015 date of injury. A specific mechanism of injury has not been described.

This is a 36-year-old female with a 11/6/2015 date of injury. A specific mechanism of injury has not been described.

Both in the cervical and lumbar region. In terms of conservative management, the patient may benefit from the addition of an SNRI and either gabapentin or pregabalin. He could also benefit from a tricyclic. I did discuss all of these with the patient and he is fairly adverse to the use of any of these types of medications because of feelings that it will affect his liver. At the same time, he is currently on methadone which he states does not seem to help him as much as morphine has in the past. A switch to extended release morphine sulfate could be performed and would help in terms of not only his neuropathic pain, but also his nociceptive pain. In terms of injection therapy, I did discuss both cervical and lumbar injection therapy with the patient. I went through with him the indications, risks, benefits, alternatives of care, likely outcome, possible complications, including but not limited to the risk of bleeding, infection, nerve injury, spinal cord injury that could be associated with injection therapy. Furthermore, because of the fact that he is a diabetic, he would be at increased risk with regards to hyperglycemia after the injection and also at increased risk for infection in general. At the same time, I did review with him the rare but catastrophic adverse events including blindness,

This is a 56-year-old female with a 1-11-2015 date of injury, when he tripped over some cables and fell.

More possible drugs treatments that are used include Gabapentin and Pregabalin. These two are thought to be effective in variety of neuropathic pain problems. They act by binding to voltage gated calcium channels. However, the side effects of this drug are somnolence and dizziness, which can be minimized by using gradual dose titration. Intravenous Lidocaine also has been reported that it brings good results in neuropathic pain. Mexiletine, an oral analogue of intravenous Lidocaine has been shown in a small study that is results in pain relief in phantom limb

Recommendation was made for second generation oral anti-inflammatory drug, pain medicine, continuation of physical therapy with acupuncture, steroid injection, and continuation of home exercise.

Celecoxib is a selective COX-2 inhibitor, is potential applied for the aggravated treatment of colonic diseases such as colorectal cancer and colitis [7, 8]. The possible mechanism of action of celecoxib is COX-2 specific inhibiting agent that inhibits the conversion of arachidonic acid to the prostaglandins that mediate normal homeostasis in the gastrointestinal tract, kidneys, and platelets and that are formed under control of COX-1[9]. Human clinical studies performed to evaluate the safe of celecoxib in inflammatory bowel disease (IBD) patients have no conclusion result yet. Thus, the controversy regarding risks and benefits of celecoxib for treatments of IBD is still going on [10]. Therefore the great caution should be used in treating

In case, there is no relief by home remedies and the problem is worsening. You can opt for over the counter medicines. Anti-inflammatory drugs like ibuprofen and acetaminophen; Hydrocortisone creams or similar types of creams will also give some relief.