A 45 year old Michigan woman involved in an auto accident sustained multiple fractures to the ribs, pelvis, L-4 and L-5, as well as a compression fracture of T-12 and L-3. She was referred to a physiatrist for low back sprain syndrome. Treatment over a four-year period included injections of decadron and marcaine; oral doses of feldene, soma and codeine; and non-steroidal anti-inflammatories. The woman suffered an upper G.I. bleed and was diagnosed with a large antral ulcer, requiring a vagotomy, antrectomy and gastrojejunostomy. A medQuest anesthesiologist/pain management specialist reported that while many pain management specialists prescribe medication similarly, the standard of care calls for a limited period of treatment with non-steroidal anti-inflammatories; testing and appropriate follow-up should accompany their continual use.