Scenario A 39-year-old man presented to the emergency room (ER) at his local hospital with obesity and severe localized pain in the right groin after doing some cleanup and sweeping in his garage the previous weekend. After examination by ER staff and a consultation from the general surgeon on call, it was identified that he likely had a nonincarcerated inguinal hernia defect. He was told to…

Scenario A 45-year-old woman presented in referral from a headache center with a long history of complex migraines and focal occipitoparietal head pain as well. The head pains seemed to be present all the time, or nearly so, while the more “typical” migraine, which was how she described it, came on every few days and lasted about a day or two. She had been prescribed numerous…

Scenario A 37-year-old woman who had been in severe pain for over 4 years after three dental procedures was referred to the clinic. Two other oral surgeons and a pain physician who specializes in facial pain had seen her over the past 2 years and concluded that the pain was likely from damage to parts of the left superior and also, secondarily, to the inferior alveolar…

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Scenario A 32-year-old woman had been involved in a farm equipment accident several years earlier and required reconstruction of her right upper extremity with multiple skin grafts and muscle transfers. She had lost one and a half fingers on her hand and had a fused elbow but remained able to feel some areas in her hand and forearm as well as most regions more proximally. However,…

Scenario A 42-year-old man came into the clinic as a referral to reposition or at least evaluate his spinal cord stimulator system. He had a long history of several revisions which he described at some length after a series of probing questions trying to unravel the precise history of what was done, when, and why. Some of these records were sent from other providers, and although…

Scenario A 49-year-old woman is referred for placement of a spinal cord stimulator from a physiatrist who sees many patients with persisting back pain and failed back surgery syndrome in general. Although this physician does place trial leads in some patients, he typically is comfortable only with fairly straightforward placements and does not do any permanent placements or implantable pulse generator (IPG) replacements. In this patient,…

Scenario A 52-year-old man is referred for placement of a cervical spine paddle lead after a successful trial by a pain physician in the community. He has had two anterior cervical discectomies with fusion in the past, at two separate levels (C45 and C56) at two separate times (3 years apart – first C56 and then C45). Although there had been improvement in his C6 distribution…

Scenario A 42-year-old woman is referred for placement of a paddle lead and implantable pulse generator (IPG) after a successful trial by an outside pain physician in the community. The woman has had three prior lumbar spine surgeries: initially, an L5-S1 R microdiscectomy, moderately successful, followed several years later by a generally unsuccessful L L45 microdiscectomy in which she had residual significant lower back pain but also…