1. Case Management Conference 2017
Collaborative Approach: Chronic Pain Management for Complex Patients
Leslie Simons, DNP, ANP‐BC and Cynthia Wolker‐Pung, RN
CASE ONE
 58‐year‐old male patient.
 Bilateral back & right lower extremity pain.
 History of 5 back surgeries
3 lumbar decompression laminectomies & 2 lumbar fusions.
Failed interventional management and physical therapy.
Questions for Case One
1. Patient also undergoing cardiac workup, problems with obtaining cardiology notes/PCP states check with cardiology/Cardiologist states check with PCP. Insurance MCR + Blue.
2. Any questions that you would like to ask?
3. Do you see any issues with this patient’s insurance?
4. What red flags do you see?
5. What are the next steps in caring for this patient?

2. Case Management Conference 2017
Collaborative Approach: Chronic Pain Management for Complex Patients
Leslie Simons, DNP, ANP‐BC and Cynthia Wolker‐Pung, RN
CASE TWO
 82‐ year‐old male patient.
 Right lower extremity pain.
 Primary caregiver for spouse with dementia.
 Problems finding driver/caregiver for wife.
 Poor Historian.
 Medical History
Type One Diabetic: DPN/CHF/HTN/MI x 2
Coronary Artery Stent, Pacemaker /Defibrillator.
Currently prescribed Coumadin.
Questions for Case Two
Patient cannot remember who primary care physician or cardiologist is, who implanted AICD, or who prescribes Coumadin.
Received permission from cardiology to discontinue Coumadin for at least 7 days.
What questions would you like to ask?
What red flags do you see?
What problems can occur?
What are the next steps for caring for this patient?