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Pt with advanced metastatic prostate cancer. I saw him several years ago and we did RFA's with mixed results. His primary sent him back to me recently seeing if there is anything else we could offer
Patient is already taking Percocet with primary care which was recently switched from hydrocodone. Percocet is working much better. No tolerance issues yet but it is early.
Looking at his recent CT and MRIs of the lumbar spine he has significant metastatic involvement in the lumbar spine. No pathologic fractures yet although there is a lot of enhancement on his STIR sequencing best seen on the sagittals in the location of these metastatic lesions
We are going to do medial branch blocks to reassess for candidacy for RFA but I am not convinced this is what he primarily needs
Questions for the group:
1) I do not treat a lot of cancer pain, in particular metastatic pain. Any other certain medications or classes of medications you find more helpful than others?
2) any other procedural thoughts for this gentleman? His central canal is wide open. There is some scattered neuroforaminal narrowing but nothing severe and he has no radicular pain whatsoever. This is all axial pain enhanced with activity/movement.
Patient is already taking Percocet with primary care which was recently switched from hydrocodone. Percocet is working much better. No tolerance issues yet but it is early.
Looking at his recent CT and MRIs of the lumbar spine he has significant metastatic involvement in the lumbar spine. No pathologic fractures yet although there is a lot of enhancement on his STIR sequencing best seen on the sagittals in the location of these metastatic lesions
We are going to do medial branch blocks to reassess for candidacy for RFA but I am not convinced this is what he primarily needs
Questions for the group:
1) I do not treat a lot of cancer pain, in particular metastatic pain. Any other certain medications or classes of medications you find more helpful than others?
2) any other procedural thoughts for this gentleman? His central canal is wide open. There is some scattered neuroforaminal narrowing but nothing severe and he has no radicular pain whatsoever. This is all axial pain enhanced with activity/movement.