The case Marcus is a 40-year-old dialysis technician who presents with severe, bilateral lower extremity pain following a right knee bursectomy in January 2006. His past medical history includes gastroesophageal reflux disease, coronary artery disease treated with a stent, hypertension, and a right knee bursectomy. He is married with no children. He has no history of substance or alcohol abuse; likewise, there is no family history of substance or alcohol abuse. The patient's present pain began in January 2006, following a right knee bursectomy. The pain initiated in the right lower extremity and subsequently spread to the left lower extremity (contiguous and mirror image spread, respectively). He describes the pain as constant burning, aching, throbbing, shocking, stabbing, lacerating, wrenching, cruel, tearing, vicious, torturing, and unbearable. He is unable to wear pants due to allodynia and is unable to walk due to severe pain – he is wheelchair bound. His numeric rating pain score is 7 out of 10 at rest and 10 out of 10 with activity. Aggravating factors include cold, touch, walking, and standing, and alleviating factors include rest and sitting. The pain is associated with allodynia, vasomotor changes, sweating, swelling, and weakness, discoloration, and ulcers in lower extremities. Marcus is angry and depressed secondary to pain. The pain has affected his relationship with his wife in the form of a decreased libido. Marcus is no longer able to socialize with friends or take annual vacations to the local state park.
|Original language||English (US)|
|Title of host publication||Core Clinical Competencies in Anesthesiology|
|Subtitle of host publication||A Case-Based Approach|
|Publisher||Cambridge University Press|
|Number of pages||6|
|State||Published - Jan 1 2010|
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