Insomnia and chronic pain

A 57-year-old male presents at a multidisciplinary pain clinic with chronic low back pain and radicular symptoms into the right lower extremity. He is overweight and ambulates slowly with the use of a cane. He had gradual onset of pain over 18 years ago with no clear precipitant. He underwent cervical discectomy for radiculopathy 6 years ago with complete recovery. An MRI 1 year ago identified spinal stenosis at the L4-5 level. Subsequent lumbar discectomy and fusion was of no benefit in reducing his pain. His activity is restricted to that around the house. He has not drunk any alcohol in the past 30 years since being diagnosed with chronic pancreatitis. He reported heavy alcohol use on weekends in his early 20s, but never any legal problems. He currently smokes one pack of cigarettes daily, drinks four cups of coffee in the morning and one in the evening, and denies any use of illegal/recreational drugs. Current medications include chlordiazepoxide/clidinium, lamotrigine (50 mg), duloxetine, clonazapam (0.5 mg), fenofibrate, quetiapine, trazadone (150 mg), and hydrocodone/acetaminophen (10 mg BID).