Patient is a 64 y/o female, hispanic with h/o HTN, hyperlipidimia and pre-diabe

Patient is a 64 y/o female, hispanic with h/o HTN, hyperlipidimia and pre-diabe

Patient is a 64 y/o female, hispanic with h/o HTN, hyperlipidimia and pre-diabetes, who presents with persistent bilateral lower back pain with radiation to left lower extremity described as constant, stabbing pain accompanied by tingling and numbness sensation of left lower extremity which limits her daily activities including her walking. She states was seen at ER a few days ago and received an shot with very minimal relief, she also had perfomed a lumbar spine X-Ray that reports degenerative disc disease. We ordered meloxicam 15mg PO QD prn pain, cyclobenzaprine 10mg PO daily at bedtime and MRI lumbar spine without contrast, we also ordered physical therapy. We will refer to pain management for possible epidural block after MRI results
ICD10 M54.16 Lumbar radiculopathy

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