Problem: A 46 yo male with chronic back pain takes large doses of over-the-counter pain medications. He works 12-hour night shifts and has to take 15-20 pills, especially Motrin (ibuprofen) and Aleve (naproxen), during the shift and about the same amount during the day in order to "function." He presents for assistance with pain management. Today's blood test results include: BMP: creatinine 3.3, BUN 25. CBC was normal. The patient had a normal CBC and BMP one month ago