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Mr Fountain Case Summary

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Mr. Fountain is a non-smoker, drinks 6 alcoholic beverages per month and has 3 to 4, 500ml bottles of caffeinated soft drinks a week. He denies any history of illicit drug or substance use.

On admission, Mr. Fountain complained of low back pain, ranging in intensity between 7 and 10, on a pain scale where 0 is no pain and 10 is the worst possible pain. He subjectively described this pain as a constant ache that permeates down into both legs, anteriorly and posteriorly, but at times can be stabbing, sharp, and burning. Sitting, standing, walking or lying down for prolonged periods can aggravate his back pain, while treatment modalities such as medications, nerve block injections, medical cannabis, TENS therapy, massage, and application
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On admission, he was taking 450mg/day of pregabalin to manage his neuropathic pain symptoms, and noted that it effectively reduced the sensations of numbness and burning within his neck, arms and legs, however he identified mild swelling in his extremities and weight gain as possible adverse effects from pregabalin treatment. With respect to the management of his headaches, nortriptyline therapy has decreased the frequency of his headaches from 5 to 2 episodes per week, but headache severity has remained unchanged, and typically rated at a 10/10. To treat the nociceptive and neuropathic pain, he is prescribed 90mg of duloxetine daily. He denies any history of depression or anxiety, however when asked about the drug’s effectiveness, he highlighted its positive effects on mood, noting that he is less emotional, less anxious and calmer since duloxetine therapy was initiated a year ago. These drug effects have allowed him to cope with the pain and stressful situations in his life more effectively. He notes that the immediate release morphine is not adequately controlling his breakthrough pain, and he also finds this medication to be constipating. He is uncertain whether Vimovo is providing him with any additional pain
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