Pain Management Expert Opines on Fentanyl Prescription for Complex Regional Pain Patient

This case involves a female patient who was a long-time patient of a local pain clinic and was prescribed Fentanyl patches for a host of complaints, primarily complex regional pain syndrome. On one occasion, while the patient was under the influence of the medication, she was involved in a serious workplace accident. The patient was working as a forklift operator in a large warehouse when she struck a support strut for a shelf, causing the entire shelving unit to collapse on her forklift. It is alleged that the patient should not have been operating the forklift while under the influence of the drugs, and that the medication she was prescribed was not appropriate for her condition.

Questions to the Pain Medicine expert and their responses

Do you routinely treat patients similar to the one described in the case?

I frequently treat patients with CRPS as well as a variety of other complex pain disorders and can speak to their proper monitoring and treatment.

What measures could have been taken to monitor the patient and determine the proper prescription of Fentanyl?

Classically, CRPS does not respond to high dose opiates. The treatments of choice typically entail neuropathic pain agents, sympathetic blockade and neuromodulation. The particular medication regimen described here is typically reserved for cancer patients and palliative care. Patients on such high dose medications are advised to abstain from driving or operating heavy machinery. One should periodically do urine testing to make sure there are no other medications being taken in addition to Fentanyl. I have served as expert witness for another CRPS case regarding a patient injured and improperly treated causing the CRPS to worsen.

About the expert

This board certified expert has a BA from University of Rochester and an MD from Drexel University College of Medicine. He is a member of American Academy of Pain Medicine, American Board of Physical Medicine & Rehabilitation and American Pain Society. Previously, he was Attending Pain Physician with New York Pain Management Group. Currently, he is President and CEO at a private pain management center.

E-004698

Specialties:

Pain Medicine