Cervicothoracic cystic dilation

The patient comes in today for a follow-up visit. He is an 18-year-old male, who was involved in a dirk bike accident in 2005. He sustained multiple traumas to his face and neck. He underwent multiple reconstructive surgeries to his face. He has cerebrospinal fluid leak as well and arachnoid cyst in the cervical spine. He has chronic neck pain and headaches as a result from his injuries. He was previously taking Roxicodone 30 mg two to four times a day from his previous family physician. He was placed on MS Contin 15 mg twice a day to replace this and he is really not getting pain relief. He has found no improvement with Lyrica. He denies any other changes in his past medical history, past surgical history, medication history, allergies, family history, social history, or review of systems.

DIAGNOSES:
Cervicalgia.
Facial pain.
Cervicothoracic cystic dilation.

RECOMMENDATIONS:
This is an unfortunate male who sustained severe injuries causing chronic pain. Because of his age, we want to keep the pain medications at the lowest possible dose to keep the pain managed. We will consider increasing the MS Contin; however, in the interim, I will continue the MS Contin 15 mg every 12 hours and I have ordered him MSIR 15 mg three times a day as needed for breakthrough pain and I have given a two-week supply and we will reassess him in two-week period of time. I explained to the patient and his mother that I do not want him to be taking the Roxicodone 30 mg and this is too high dose for him to be taking. His pain should be managed more with longer acting pain medication. He may need higher dose of MS Contin, which we will consider at his follow-up and I cut back on the short-acting medications. He has had adverse reactions to fentanyl patches and the OxyContin in the past. Other options will be starting MS Contin with the Opana, but if he does well with MS Contin, we will recommend continuing to titrate that medication.

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