Pain consultation

**Chronic Pain Management Clinic Consultation** John Doe was seen in consultation on 1 November 2024, referred by Dr. Emily Smith on 15 October 2024 for chronic hand pain. The consultation lasted 45 minutes. John presented with persistent pain in his right hand, which he described as a sharp, stabbing sensation that worsens with movement and cold weather. The pain is rated as 7 out of 10 and significantly impacts his ability to perform daily tasks, including his work as a carpenter, and affects his sleep and mood. The pain interference score was 8, with the most severe components being interference with work and sleep. Specific symptoms highlighted included difficulty gripping tools and frequent waking at night due to pain. John has previously tried physiotherapy, which provided temporary relief, and counselling to manage the psychological impact of chronic pain. **Nonpharmacologic Management** John has undergone physiotherapy and counselling, which have provided some relief but not long-term improvement. **Pharmacologic Management** John is currently taking ibuprofen and gabapentin, which have helped reduce the pain intensity but not eliminated it. He previously tried acetaminophen, which was ineffective, and stopped it after two months. **Interventional Management** John has received two steroid injections in the past year, administered by Dr. Kelly, which provided temporary relief. **Past Medical History** 1. Hypertension 2. Type 2 Diabetes **Past Surgical History** 1. Appendectomy in 2010 **Allergies** Penicillin - causes rash **Medications** 1. Ibuprofen 2. Gabapentin 3. Metformin 4. Lisinopril **Social History** John lives with his wife and two children. He works as a carpenter, does not smoke, and drinks alcohol occasionally. **Physical Examination** John appeared calm but in mild distress due to pain. Vital signs were stable. He exhibited guarding of the right hand, with noticeable swelling and tenderness over the metacarpophalangeal joints. His gait was normal, but he had limited range of motion in the right hand compared to the left. **Investigations** 1. MRI of the right hand in September 2024 showed mild osteoarthritis. **Diagnostic Code(s):** M19.041 - Primary osteoarthritis, right hand **Impression and Plan** John's condition is consistent with osteoarthritis of the right hand, exacerbated by his occupation. We discussed the potential benefits and risks of continuing physiotherapy and considering occupational therapy. I recommended a trial of a topical NSAID and referred him to a pain management specialist for further evaluation. Follow-up: John will return in four weeks for reassessment and to discuss the effectiveness of the new treatment plan. It is a pleasure to be involved in the care of this patient.