Tramadol

01/14/16 Progress Report noted that the patient has severe and constant pain. It is associated with numbness, tenderness, and restricted motion. Current pain level is 8/10. The patient is here for injection to the left subtalar joint. The exam of the left ankle revealed intact skin. There was no erythema or abrasion. No signs of infection. NVI distally. Distal sensation intact and brisk capillary refill. Clinical Assessment: The patient would like to go ahead with the

12/24/15 Progress Report describes that the patient has right knee pain. The pain is frequent. It is aching and burning in quality. The current pain level is 0/10 and worst pain is 4/10. Bending, squatting, walking, weight bearing, changing clothes and ROM aggravate the pain. Rest, ice,

A visit note from Evan Ross, DPM, dated 09/20/2017, indicated that the claimant presented with pain in her whole leg rated as 10/10. She had plantar fasciitis in the left foot. She was diagnosed with posterior tibial tendon dysfunction of the right foot, ligament laxity, and left foot plantar fasciitis. Physical therapy was recommended.

Dr. Justin Clayton at the Mercy Clinic Orthopedic Surgery evaluated the claimant on April 6, 2018. Dr. Clayton stated the claimant may have rheumatoid disease and prescribe him Meloxicam. In addition, he reported the claimant would be referred for further arthritis evaluation (Ex. 23F).

Based on the progress report dated 08/23/16, the patient complains left knee pain upon walking. Discomfort was described as aching, tingling, intense, severe, continuous, pain, discomfort, increasing with movement and varying with activity. Pain is rated as 5/10 without medications and 4/10 with medications.

Per the medical report dated 06/27/2016, the patient complaints of right ankle pain. It was noted that Elavil and Naprosyn provide relief about 20-40% each. Patient’s current medications are Ambien, Naproxen, and Gabapentin. Patient has tried Gabapentin and Tramadol which did not help. Treatment plan includes application of Voltaren gel 1% to affected area four times a day and as needed, increasing Naproxen to 500 mg, addition of omeprazole 20mg once a day, Elavil 25mg at night, and Lidoderm patches 5% for pain.

Based on the medical report dated 03/29/16 by Dr. Riley, the patient complains of increased pain to both heels, left greater than the right. She states that the pain is most severe with the 1st step in the morning or after periods of rest. She is requesting new custom orthotics, as her existing pair have become very worn. They are more than 2 years old. Additionally, she sustained a trip and fall Injury on 2/2 with her knee "giving out." Two days prior to this visit, patient is with pain and swelling to the left great toe joint. She is unclear if the injury occurred with the fall, or in the process of

Per office visit notes dated 8/7/2016, patient presents for a follow up for neck pain, left elbow pain and bilateral wrist pain. Current medications include Naprosyn EC 500 mg, Tramadol 50 mg, Lyrica 50 mg and Levora-28 0.15/0.03 mg. Patient was recommended retrial of Celexa for her depressed mood related to her chronic

01/11/16 PT Evaluation Report documented that the patient is showing good progress towards goals, with a decrease in pain in the right lower leg, ankle and foot when ambulating. But the remaining impairments, including reduced strength, limited ROM and gait deviations cause poor ability to ambulate. Continue skilled PT is necessary in order to address the remaining deficits. Sort-term and long-term goals were discussed.

As per office notes dated 5/4/16, the patient is seen for bilateral elbow pain and bilateral wrist pain. She rates the pain as 3/10 with medication and 7/10 without medication. She is active for at least six hours a day and has energy to make plans. Her activity level has

Based on the progress report dated 05/17/16, the patient presents for reevaluation of her right knee pain. It has been about the same though she states that when she gets acupuncture, it does decrease pain for a period of time and allow her to exercise more. She has been walking 45 to 50 minutes twice a day. She uses

DOI: 2/3/2014. Patient is a 20-year-old male cashier who sustained injury to his right ankle when he slipped and fell. Per OMNI, he was diagnosed with right ankle sprain.

After analyzing findings from the initial evaluation the patient’s primary issue is severe right hip/knee pain which is limiting his ability to participate in PT, as well as perform functional activities. Therefore, identifying the source of pain is the main priority since the patient’s pain is 5/10 at rest and 7/10 with bed mobility, transfers, and ambulation. Taking into consideration the high pain levels and unknown source; the patient was discharged and recommended to follow up with his MD. This being said, below are potential concerns involving the combination of medications and impairments during interventions if this patient remained in Neuro Clinic with minimal pain.

The patient has attended 3 PT sessions for the ankle per daily note dated 04/05/13.

“Failure to respond to all available conservative treatment options including activity modification (e.g., restriction of athletic pursuits and avoidance of symptomatic motion), pharmacological intervention (e.g., nonsteroidal anti-inflammatory drugs [NSAIDS]), injections of local anesthetics into the joint) and physiotherapy”