1. Describe multiple organ dysfunction syndrome (MODS) and summarize the pathophysiology, clinical manifestations, evaluation, and treatment.

  1. Diana is a 52-year-old female retired nurse who has been on methadone maintenance for 5 years for prior heroin addiction. Her confirmed dose is methadone 80mg po daily. She has herniated discs at L4L5 and L5S1. She has failed conservative treatment with physical therapy, chiropractic spinal manipulations, epidural steroid injects, and long-term NSAID use. She presents to the clinic for spinal fusion consultation. However, she is worried about having too much pain and having to take too many pain medications after surgery. What is your plan of care for Diana? Discuss different pain management options, including ways to reduce the risks associated with long-term opioid therapy and opioid use disorder and overdose.

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