system: You are a clinical documentation assistant. Generate only the requested clinical note section using only facts from the dialogue. Do not invent information. If the section is not supported by the dialogue, return N/A.

user: Section: GENHX

Dialogue:
Doctor: Good afternoon, sir.
Patient: Good afternoon, doctor.
Doctor: Refresh my memory, please, how old are you, sir?
Patient: I'm forty nine.
Doctor: Also, I need you to remind me, when was your lower back surgery?
Patient: It was in January of two thousand five. What was the name of the surgery, again?
Doctor: It was a lumbar disc replacement. So, how are you feeling today?
Patient: Truthfully doctor, the surgery did nothing. I'm still in a lot of pain.
Doctor: Besides the surgery, what other interventions have you tried?
Patient: I have them written down, let me look. Um, I did acupuncture, T E N S unit at P T, and I've been to the chiropractor too.
Doctor: Have you taken any medicines?
Patient: Yeah, I have those written down here. I've taken Elavil, Topamax, Cymbalta, Neurontin, and Lexapro.
Doctor: Are you still taking any of these?
Patient: No, I had bad side effects to some, and the others just didn't do anything.
Doctor: Have you had any injections for this pain?
Patient: I've had a few into the, um, piriformis.
Doctor: Did that do anything?
Patient: Um, it provided some brief relief, I guess. I had a Botox procedure done on March eighth two thousand six.
Doctor: How did this work?
Patient: Honestly, it did nothing.
Doctor: Where is your pain, exactly?
Patient: I'd say its seventy five percent in my butt and leg, and twenty five percent in my lower back.
Doctor: Are you able to workout, or exercise, anything like that?
Patient: I've tried to increase how much I walk, but when I do I get spasms in my lower back.
Doctor: I see, with ten being the worst pain of all time, how would you rate your pain today?
Patient: I'd say it's a six out of ten today.
Doctor: What adjectives would you use to describe the pain?
Patient: Um, I'd say its shooting, sharp, and, um, aching.
Doctor: Specifically, what activities make the pain worse?
Patient: Well, lifting, standing for a long time, or, um, squatting. I can't do that anymore.
Doctor: Does anything make the pain better?
Patient: Um, sitting back, ice, and I guess there's some improvement with the pain medication.
Doctor: Is the pain constant, or does it come and go?
Patient: It's constant now, but, um, the intensity of it comes and goes.
Doctor: Are you able to sleep at night?
Patient: Not really, it is affecting my sleep, which in turn affects my mood.
Doctor: So, overall, I can summarize and say you're not happy with your pain relief so far?
Patient: Yes, doctor, that's correct.

assistant: This is a pleasant 49-year-old gentleman post lumbar disc replacement from January 2005. Unfortunately, the surgery and interventional procedures have not been helpful in alleviating his pain. He has also tried acupuncture, TENS unit, physical therapy, chiropractic treatment and multiple neuropathic medications including Elavil, Topamax, Cymbalta, Neurontin, and Lexapro, which he discontinued either due to side effects or lack of effectiveness in decreasing his pain. Most recently, he has had piriformis injections, which did give him a brief period of relief; however, he reports that the Botox procedure that was done on March 8, 2006 has not given him any relief from his buttock pain. He states that approximately 75% of his pain is in his buttock and leg and 25% in his back. He has tried to increase in his activity with walking and does note increased spasm with greater activity in the low back. He rated his pain today as 6/10, describing it is shooting, sharp and aching. It is increased with lifting, prolonged standing or walking and squatting, decreased with ice, reclining and pain medication. It is constant but variable in degree. It continues to affect activities and sleep at night as well as mood at times. He is currently not satisfied completely with his level of pain relief.