Background

A 54-year old male sustained a low back, neck and bilateral wrist injury during the course of his employment, resulting in chronic low back and neck pain which appeared to be neuropathic in nature. For numerous years, the claimant continued to take multiple doses of narcotic medications for his ongoing pain as well as a hypnotic for pain-induced insomnia. Despite this, he continued to complain of shooting, tingling, numbness, stabbing, and burning pain in his upper and lower extremities. He was diagnosed with upper extremity and lower extremity radiculopathy. Cervical epidural steroid injections were performed periodically. The claimant was not being prescribed any adjunct medications for the treatment of his neuropathic pain symptoms and future surgery was questionable.

Intervention

A comprehensive review of the claimant’s medical records and prescription history by the clinical pharmacist revealed inappropriate dosing of a sustained-release narcotic, excessive dosing of an immediate-release narcotic inappropriate for chronic use, and excessive use of a sedative hypnotic.

Results

Recommendations made by the clinical pharmacist included addition of an adjunct medication for more adequate treatment of his neuropathic pain symptoms and transition to a different immediate-release narcotic; this would allow for reduction in narcotic doses (while reducing the risk for respiratory depression due to inadequate dosing and acetaminophen toxicity due to excessive use) and elimination of sedative hypnotic due to restoration of sleep architecture with more satisfactory pain control.

Potential Savings

Current annual prescription costs: $15,681
Annual prescription costs following therapy modifications: $4,138
Potential savings: $11,543/year