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Anna, a 57 year-old female with low back pain presents to your pain clinic.  She describes sharp pain in the back down both legs that is continuous in nature

  • PMH: bipolar disorder, depression and diabetic neuropathy
  • PSH: lumbar laminectomy, lumbar discectomy x 2
  • The patient describes no benefit in her symptoms after back surgery
  • MRI with/without contrast: L4/5 hemilaminectomy, scar tissue at L4/5, L5/S1 levels secondary to post-surgical changes
    • Unchanged from prior MRI studies
  • The patient has had epidural steroid injections without benefit
  • She is not interested in having spinal cord stimulation

Medication history:

  • The patient has been tried on hydrocodone/acetaminophen, gabapentin, pregabalin without benefit
  • She has been on duloxetine for her pain with a minimal degree of efficacy
  • She is taking paroxitene for her psychiatric issues
  • She asks if there are any agents that would provide pain relief for her back issues and help with her diabetic neuropathy
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