Opinion ID: 3046994
Heading Depth: 1
Heading Rank: 2

Heading: The Evidence Regarding Debilitating Pain

Text: and the Side Effects of Its Treatment There was an extensive medical record before the ALJ. A substantial segment of that record dealt with the extent of Ianuzzi’s physical, exertional limitations. His attack on the Commissioner’s decision, however, focuses on the evidence of disabling pain and the consequences of its treatment and, for present purposes, we will limit ourselves to that evidence. Following a motor vehicle accident, Ianuzzi sought help from his family physician, 3 Dr. John F. Reinhardt, complaining of chronic and constant headache. After an MRI and other diagnostic work, Dr. Reinhardt diagnosed Ianuzzi as having whiplash, headaches and degenerative joint disease and referred him to Dr. James Burke, a brain surgeon, for pain management. Upon examination, Dr. Burke noted that Ianuzzi had radiographic evidence of degenerative disc disease of the cervical spine and appeared to be symptomatic for occipital neuralgia. Dr. Burke turned the pain management responsibilities over to Dr. John Johnson, an anesthesiologist, on May 31, 2005. Dr. Johnson was Ianuzzi’s treating, pain management physician continually from that date through July 20, 2006, when he submitted the report that is relevant here. Dr. Johnson’s initial, primary diagnoses were: (1) bilateral occipital neuralgia; (2) myofascial pain; and (3) cervical and lumbar radiculitis. In the course of regular visits during this period, Dr. Johnson treated Ianuzzi with trigger point injections, occipital nerve blocks, cervical epidural steroid injections, and multiple medications. These treatments produced short term relief, but the pain thereafter returned to or near the original levels. The District Court accurately described Dr. Johnson’s July 20, 2006, report as follows: In the report, Dr. Johnson indicates that he first saw Plaintiff on May 31, 2005 and that he last saw Plaintiff that day. Dr. Johnson listed Plaintiff’s impairments as “occipital headaches 2-3x’s day – pain radiates to shoulders, back pain, neck pain.” Dr. Johnson noted that Plaintiff’s then current treatment included lumbar epidural steroid injections, cervical epidural steroid injections, bilateral occipital nerve blocks, Percocet and Fentanyl 4 patches,19 and he described Plaintiff’s clinical findings as “tenderness in occipital regions bilaterally, tenderness along paraspinal musculature of cervical spine and diffuse tenderness in lumbar spine region.” Regarding Plaintiff’s prognosis, the legible portion of Dr. Johnson’s response indicated that Plaintiff’s pain would continue, and that his range of motion and activities would continue to be decreased. 19 Fentanyl skin patches should only be used to control moderate to severe chronic (around the clock, long-lasting) pain that cannot be controlled by the use of other pain medications in people who are tolerant (used to the effects of the medication) to narcotic pain medications because they have taken this type of medication for at least one week. Fentanyl skin patches should not be used to treat mild pain, short-term pain, pain after an operation or medical or dental procedure, or pain that can be controlled by medication that is taken as needed. See www.nlm.nih.gov/medlineplus/druginfo (last visited 4/17/2008).