A 68-year-old man presents with 3 months of burning, stabbing pain over the left chest wall that wakes him most nights and makes even his shirt touching the skin intolerable. Three months ago he had a painful vesicular rash in the same area that has since healed. His history includes benign prostatic hyperplasia with hesitancy and nocturia and morning lightheadedness on standing, which make any tricyclic antidepressant relatively contraindicated. Medications are tamsulosin 0.4 mg daily, acetaminophen as needed, and amitriptyline 25 mg at bedtime started 4 weeks ago, with no improvement in pain. On examination there is faint scarring over the left T6 dermatome with allodynia to light touch and no active vesicles, and his eGFR is 48 mL/min/1.73 m² (60 or higher).
| Heart rate | 94/min |
| Respiratory rate | 16/min |
| Temperature | 36.8 °C |
| O2 saturation | 97%, room air |
| Blood pressure | 138/82 mm Hg supine, 114/70 mm Hg standing |
Question 1 of 30
Which of the following are the most appropriate management steps for his pain at this visit?
Select 2. (0 / 2 selected)
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