Bilateral wrist pain

The patient comes in today for a follow-up visit. She continues to have chronic polyarticular joint pain from rheumatoid arthritis. She also has diffuse myofascial pain from fibromyalgia. She has taken Lyrica and has not noticed significant change at this point. Pain level is 6/10 on a visual analog scale with medications, and 10/10 without medications. She denies any memory impairment, oversedation, constipation, nausea, itching, or high on the medications. She is alert and functional with better quality of life since coming to the Pain Center. She has had arthrocentesis in her knees with cortisone injections for her shoulder pain. She never had any viscosupplementation at this point. We have ordered x-rays of her joints. She has not done yet. Her father has recently been in the hospital for undergoing surgery for pancreatic cancer and is on ventilator. She denies any change in her past medical history, past surgical history, medication history, allergies, family history, social history, or review of systems.

DIAGNOSES:
Rheumatoid arthritis.
Bilateral knee pain.
Bilateral ankle pain.
Bilateral wrist pain.
Bilateral shoulder pain.

RECOMMENDATIONS:
I still wanted to get her x-rays of the knees and shoulders that I have ordered. We will consider viscosupplementation and PRP. She will continue with Humira and methotrexate treatments per rheumatologist. We will continue Actiq 600 mcg one every three to four hours as needed for breakthrough pain, #120 dispensed today. We will have her followup in two weeks when her medications are due. We will consider increased Lyrica. We will see her back in two-week period of time for reevaluation.

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