Documenting a pain medicine clinic
Procedure notes with pre- and post-block scores, opioid taper letters to the GP, and letters back to the referrer.
A second diagnostic medial branch block
Second diagnostic medial branch block, bilateral L4/5 and L5/S1 facets. First block on 8 September with lignocaine gave 90% relief for two hours.
Today bupivacaine 0.5%, 0.5 mL at each medial branch, under fluoroscopy. No complications.
Pain 7 out of 10 before, 1 out of 10 at thirty minutes. She'll keep a pain diary for the next eight hours.
If relief is 80% or better and lasts longer than with the lignocaine, she's a candidate for radiofrequency neurotomy.
Oxycodone-naloxone 20/10 BD now. Letter to the GP to taper by 10 mg every two weeks.
Procedure
Second diagnostic medial branch block, bilateral L4/5 and L5/S1. Fluoroscopic guidance. Bupivacaine 0.5%, 0.5 mL per medial branch.
Previous block
8 September, lidocaine: 90% relief for 2 h.
Response
NRS 7/10 pre, 1/10 at 30 min. Pain diary for 8 h.
Complications
Nil.
Plan
- Radiofrequency neurotomy if relief ≥ 80% with longer duration than lidocaine
- Oxycodone-naloxone 20/10 mg BD: GP to taper by 10 mg every 2 weeks
The letter to the practice running the taper
Dr Anita PearceBayview Medical Centre
RE: Price, Amanda (DOB 30/01/1979) · Synthetic patient
Dear Dr Pearce,
Ms Price had a second diagnostic medial branch block today at L4/5 and L5/S1 on both sides. Her pain fell from 7/10 to 1/10. If her diary shows a longer response than with the first block, I will offer her radiofrequency neurotomy.
She is taking oxycodone-naloxone 20/10 mg twice daily. Please reduce by 10 mg of oxycodone every 2 weeks, morning dose first, so she is off it in 8 weeks. She knows withdrawal symptoms in the first few days of each step are expected.
I will see her in 3 weeks with the diary.
Kind regards,Consultant pain medicine physician
