Case 80: A Chronic Pain Patient



Today you are scheduled to anesthetize a 29-year-old female (5 ft 8 in. and 70 kg) for reimplantation of ureters into the bladder. She has had multiple urological surgeries after a failed one 5 years ago. She is a chronic pain patient on the usual medication including fentanyl patch. You see her for the first time in the preoperative area. Her heart rate is 86 bpm, BP 145/85, and respiratory rate 30. She complains about severe abdominal pain (10/10). Her mum and dad, who are at the bedside, inform you that this is her usual pain level, only today it seems worse. The patient agrees but tells you that she has not taken any of her usual pain medication this morning except for the fentanyl patch. She has been fasting since midnight. The patient requests IV pain medication before you take her back to the operating room.


Chronic pain Physical exam 


  1. 1.
    Jauhar S. The demise of the physical exam. N Engl J Med. 2006;354:548–51.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Stanford University Medical CenterStanfordUSA

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