The patient initially presented with gradually increasing perianal burning pain. He was reluctant to take regular pain medication due to side effects, opting for alternating doses of tramadol 50mg orally and prolonged release morphine 10mg orally as needed. He presented to our pain clinic with severe pain that limited his daily activities.
His pain was exacerbated by defecation, standing and walking. He rated the pain as 6/10-9/10. There was no radiation of the pain. Simple analgesics were ineffective. He had no other co-morbidities.
