Rheumatoid arthritis

The patient comes in today for a follow-up visit. She continues to have polyarticular joint pain with rheumatoid osteoarthritis. She also has pain and peripheral neuropathy. Pain level is 3/10 on a visual analog scale with medications and 8/10 without medications. She denies any memory impairment, oversedation, constipation, nausea, itching, high or buzz on the medications. She is alert and functional and has a better quality of life on medications. She is resting well at night. She denies any change in characteristics or nature of her pain. She denies any changes in her past medical history, past surgical history, family, social history, or review of systems.

DIAGNOSES:
Rheumatoid arthritis.
Peripheral neuropathy.
Cervicalgia.
Wrist pain.
Knee pain.

RECOMMENDATIONS:
We will continue with the current regimen that is keeping the pain stable. She appears using the medications properly. I have renewed the MS Contin 30 mg one every 12 hours and Dilaudid 4 mg one b.i.d. p.r.n. for breakthrough pain for one month supply. We will see her back in 30-day period of time. If she has any problems in the interim, she will contact the office. I have discussed with the patient and her husband about doing peripheral nerve blocks for her peripheral neuropathy. They are interested in this therapy. Currently, she has no medical coverage. She has been on Cymbalta, Lyrica, Neurontin, and Celebrex without any improvement in her symptoms in the past.

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