Recommendations

■ Begin an ER pain medication, such as Oxycontin or MS-Contin.

■ Add a neuropathic pain medication, such as Lyrica, Neurontin, or Cymbalta.

■ Continue the Percocet for breakthrough pain.

■ Continue the muscle relaxant for muscle spasms.

■ Send Peter for a modified physical therapy regimen or a multidisci-plinary pain rehabilitation program.

QQuestions to Consider

1. Is using an extended release pain medication indicated for Peter? If yes, why?

2. What role is the depression and anxiety Peter feels about the loss of his job playing in the scenario? What about his relationship with his wife? Is an antidepressant indicated?

3. Is Cymbalta a good choice for Peter's leg pain and depression?

4. Will Peter continue to need opioid medications or is there a possibility that he could be converted to nonopioid medications?

5. How would you decide if Oxycontin or MS-Contin is the best choice for Peter?

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