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What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis.

ABSTRACT: BACKGROUND:Low back pain is a common symptom arising from many possible sources and includes the possibility of the contribution of remote pathology. This report describes a patient with bilateral osteonecrosis of the femoral heads presenting with a primary symptom of low back pain. CASE PRESENTATION:A 37-year-old male presented for evaluation of dominant pain that existed for approximately 6-12 months and was located in the right low back. Milder pain was also reported in the right hip. Low back and hip pain were both aggravated by weight-bearing activities. An evidence-based diagnostic evaluation revealed little indication for a primary pain source originating from low back structures. Radiographs revealed bilateral osteonecrosis with evidence of left femoral head collapse. CONCLUSION:Hip osteonecrosis may have contributed to an atypical presentation of low back pain due to aberrant localization of pain and/or combined with altered biomechanical loading of musculoskeletal structures.

SUBMITTER: Minkalis AL

PROVIDER: S-EPMC4593036 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis.

Minkalis Amy L AL Vining Robert D RD

The Journal of the Canadian Chiropractic Association 20150901 3

<h4>Background</h4>Low back pain is a common symptom arising from many possible sources and includes the possibility of the contribution of remote pathology. This report describes a patient with bilateral osteonecrosis of the femoral heads presenting with a primary symptom of low back pain.<h4>Case presentation</h4>A 37-year-old male presented for evaluation of dominant pain that existed for approximately 6-12 months and was located in the right low back. Milder pain was also reported in the rig ...[more]

PMID: 26500365

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Project description:BACKGROUND:Long-term opioid treatment for chronic non-cancer pain has become controversial, given the increasing prevalence of opioid dependence. However, there is little information on therapeutic strategies for this condition in Japanese patients. Here, we present a case of successful management of iatrogenic opioid dependence with tramadol in a patient with chronic low back pain. CASE PRESENTATION:A 68-year-old male suffering from intractable low back pain was referred to our pain clinic. He was previously treated in another hospital with transdermal fentanyl patches 6?mg/day and fentanyl sublingual tablets (100??g as required) for this condition. On the basis of medical examination, including a review of the patient's medical history, physical examination, X-ray, and his family statement, we diagnosed him with iatrogenic opioid dependence due to inadequate fentanyl use. Then, we developed a treatment plan consisting in fentanyl detoxification with a weak opioid, tramadol. At first, the use of fentanyl sublingual tablets was interrupted after obtaining informed consent. Then, we reduced the dose of transdermal fentanyl 1?mg per 4-5?days replacing with oral sustained-release tramadol. The patient developed mild to moderate withdrawal symptoms during this period, which could be effectively managed by supportive treatments. The hospital psychiatry liaison team continuously provided the patient and his wife with information, counseling, and education regarding the treatment of opioid dependence. Throughout the detoxification process, his reported pain did not exacerbate, even slightly improved over time. The final prescription was sustained-release tramadol 300?mg/day without fentanyl, and his activities of daily living drastically improved. However, unfortunately, he died due to an aortic dissection of stent-graft edge 65?days after surgery. CONCLUSIONS:Our case highlighted that sustained-release tramadol could be effectively applied as a detoxification agent for iatrogenic opioid dependence in patients with chronic non-cancer pain.

Dataset Information

What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis.

Publications

What is the pain source? A case report of a patient with low back pain and bilateral hip osteonecrosis.

Similar Datasets

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