Patients with chronic pain on long-term opioid therapy usually follow-up every 30 days as part of their routine evaluations prior to receiving their prescriptions. Since pain physicians often act as a substitute for the patients primary care provider, they must be vigilant about unexpected medical problems that can arise in these patients. We present the case of a 66-year-old female with multiple areas of pain that had previously been managed with long-term opioid therapy. Although she hadnt traveled internationally in years, the patient was able to travel to Peru with accommodations. When she returned, she experienced an acute exacerbation of knee pain from the intensive hiking regimen. The patient underwent an extensive work up led by pain management, which acted as a surrogate for primary care. After further evaluation of the patients history and wounds, she was diagnosed with leishmaniasis, a parasitic infection that she likely acquired while in Peru. When treating chronic pain in patients on long-term therapy, the focus is often on opioid management. Pain physicians treating patients with new and unusual symptoms should be on the lookout for acute medical problems. Pain physicians should have parasitic infections, along with the acute bacterial or viral infections, on their radar, especially for patients returning from international travel.
Key words: Leishmaniasis, Mucocutaneous Leishmaniasis
|
