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A 30-year-old man presented to his orthopedic surgeon to repair a clavicular malunion sustained from a prior skiing accident.

This would be the first of many shoulder surgeries over the following years including SLAP repairs, Bankart repairs, glenoid fracture repairs, labral reattachments and decompressions.

After each surgery extended Percocet courses were prescribed.

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The surgeon documented that the patient was possibly developing some sort of pain syndrome and referred him to pain management.

He was seen by several anesthesiology-trained pain specialists.

At the pain clinic he signed a controlled substance agreement.

He was given Oxycontin, Percocet, Lyrica, and an NSAID.

Over several years time he required increased titration of his prescriptions.

At a PT visit his hand was noted to be blue and he was diagnosed with CRPS.

Three stellate ganglion blocks were done without any sustained success.

A spinal cord stimulator trial was done without any pain relief.

Then a urine drug screen in October was negative for his prescribed oxycodone or oxycontin.

The pain doc Dr. T documented there was no evidence of abuse or diversion, and at that time the patient declined an opioid detoxification program.