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.

Clinical note:
Symptoms: shooting, sharp, aching pain, increased spasms in lower back with increased activity, affecting sleep and mood
Diagnosis: post-lumbar disc replacement, chronic pain syndrome
History of Patient: surgery in January 2005, unsuccessful interventional procedures including acupuncture, TENS unit, physical therapy, chiropractic treatment, discontinued neuropathic medications due to side effects or lack of effectiveness, piriformis injections provided brief relief, Botox procedure on March 8, 2006 did not alleviate buttock pain, pain primarily in buttock and leg (75%) with some in lower back (25%), pain rated 6/10, constant but variable intensity, worsened by lifting, prolonged standing or walking, squatting, improved with ice, reclining, and pain medication
Plan of Action: N/A