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Using Measurement-Based Tools to Improve Pain Care 

Using Measurement-Based Tools to Improve Pain Care
Chapter:
Using Measurement-Based Tools to Improve Pain Care
Author(s):

David J. Tauben

DOI:
10.1093/med/9780199768882.003.0011
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date: 27 July 2021

Alice Cluny is a 26-year-old woman with an 8-year history of pelvic pain, onset at age 18 years following the birth of her first child. She carried two further pregnancies, requiring intermittent hydrocodone for her persistent ill-defined pelvic and bladder symptoms. At age 23 years a laparoscopic diagnosis of endometriosis was made and she was treated with cauterization of suspect lesions without benefit. Follow-up laparoscopy showed no further pathology. Ongoing pelvic pain prompted several months of gynecologic surgeries: vestibulectomy, bilateral staged oophorectomy/salpingectomy, and finally hysterectomy. Pain persisted, and urologic diagnosis of interstitial cystitis was made, prompted by painful frequent culture-negative dysuria, a “suspicious” cystoscopic biopsy, and several courses of transurethral procedures and instillations followed by complications of urinary retention requiring urethral self-catheterization 4 times daily. During these urogynecologic treatments, she was treated with escalating doses of opioids: hydrocodone, then oxycodone, then morphine extended release, then OxyContin at a dose of 40 mg 3 times daily. She was also prescribed carisoprodol 350 mg 3 times daily and alprazolam 1 mg 3 times daily. Her primary care physician took over her opioid prescriptions after there was “nothing left for the specialists to do.” The primary care physician became concerned about visits and calls requesting early refills and concurrent requests for pain medication by her other treating specialists, then discharged Alice from her practice for “addiction and drug-seeking behavior.”

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