Gerard (62 years old)

Gerard is a 62-year-old truck driver who started suffering from severe left knee pain 5 years ago. He was diagnosed with OA via X-ray. The pain has worsened in the past year due to a peroneal nerve injury caused by arthroscopy. Now he walks with the aid of a stick, but his weight-bearing ability is very limited, and he experiences rest and nocturnal pain.

In his medical record, the following is noted:

• Severe diabetes mellitus since 8 years (treated with insulin, metformin and GLP1 receptor agonists)
• Diabetic neuropathy
• Hypertension and chronic renal failure (treated with angiotensin receptor blockers)
• BMI: 28
• Clinical findings:
  • Blood pressure: 125/80 mmHg
  • HbA1C: 7.0%
  • eGFR: 35 ml/min

His pain medication history, so far without satisfactory results:

• Analgesics (paracetamol, dipyrone): poorly effective
• NSAIDs and COX2 inhibitors: somehow effective but inadequate for Gerard’s conditions
• Opioid derivates: induced vomiting
• Gabapentinoids (gabapentin, pregabalin) and duloxetine: induced dizziness and drowsiness
• Escitalopram with physiotherapy and weight reduction: no relevant improvement