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.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. What measures could have been taken to monitor the patient and determine the proper prescription of Fentanyl?
Expert Witness Response E-004698
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. 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. I am board certified in pain medicine. I have published on Chronic Pain Disorders in several textbooks and peer-reviewed journals and have lecture around the country on treatments for complex pain disorders, including CRPS.
Expert Witness Response E-008463
I am highly qualified to review this case and glad to assist. I treat patients with opioids and who have CRPS and cervical radiculopathy. I have done numerous clinical trials on this. It is important to monitor these individuals for effectiveness and side effects, and to provide them with proper guidance with respect to opioids and driving (i.e. risk of psychomotor and cognitive effects). I have also been involved in patient care, teaching and research since 2000. Currently I am Director of the pain treatment center at a major university medical center.