In this article, we will discuss a case report on back pain.
In the treatment plan for back pain, there is the option of medication, but the case presented here is a case of side effects caused by medication.This is not a general report of side effects, but rather a rare case of symptoms that may be useful for reference.
Case Report
Male, 29 years old
No history of serious disease.
The patient came to the outpatient clinic complaining of intermittent sharp and worsening burning pain, occasional numbness in the left buttock, and stabbing pain in the posterior thigh.
The man's symptoms started two years ago and were initially rare and mild, but worsened six months before his visit, interfering with his sleep and study.
She stated that she had no history of bowel disorders or incontinence or trauma to the spine.She also stated that she had no generalized symptoms or urinary symptoms.
Physical examination revealed tenderness in the L5 vertebrae and sacrum, pain during lumbar flexion and limited range of motion.
On physical examination, the left SLR test was positive.
These findings were consistent with sciatica.
BMI values were also reported to be greater than the norm.
The man was counseled on proper diet and exercise, and if there was no improvement with ibuprofen alone, gabapentin 300 mg at bedtime was prescribed at 800 mg TID for one week.
At the same time, she was recommended to undergo physical therapy.
Radiographs of the lumbar spine and bilateral hip and pelvis showed partial sacralization of the L5 vertebrae and minimal retroversion of L4 relative to L5.
There was no evidence of pelvic or hip fracture, dislocation or diabetes.
At a follow-up done 3 weeks later, he reported minimal improvement with ibuprofen and gabapentin.
At this point, he had not started physical therapy.
The gabapentin dose was changed to 300 mg in the morning and 600 mg at bedtime. An MRI of the lumbar spine was performed and showed a 5 mm central posterior protrusion of the L4-L5 disc without significant dural sac or nerve root compression.
The patient was encouraged to follow up on the MRI results and return to the clinic in 4 days for further pain management.He informed me that the increased dose of gabapentin had relieved his sciatica to some extent, but that he continued to have considerable back pain.
At that time he was started on ibuprofen and gabapentin plus tramadol 50 mg TID as needed for the pain.
The patient returned for a follow-up visit three days after starting the tramadol.
He reported that the tramadol had completely resolved his back pain, but after the second dose of tramadol, he was experiencing frequent urination.
The man informed me that he needed to urinate at least 15 times in 24 hours.
They also told me that their symptoms were suggestive of erectile dysfunction, involving the absence of morning erections, the inability to maintain an erection, and the inability to ejaculate or have an orgasm.However, he denied any dysuria or systemic symptoms and reported having the same fluid intake.
Urinalysis results were normal.
Two weeks later, the patient returned for a follow-up visit.
His pain was well controlled with Norco, and within 24 hours of stopping the tramadol, his urinary and erectile dysfunction had completely resolved.
He is scheduled to start physical therapy the following week and is doing very well.
Abdalla Hassan, Cindy Chen, Pain management in our daily practice: should we re-evaluate?, Oxford Medical Case Reports, Volume 2015, Issue 11, November 2015, Pages 349-350,
Point
The side effects of Tramadol were reported to be erectile dysfunction and dysuria, but the incidence of these side effects in drug trials was about 1%.
This drug is sometimes used to treat premature ejaculation, and according to the FDA, there have been reports of dysuria, but it is not common.
In the first place, dysuria usually occurs in people in their 50s, so this is a rare case of drug-related harm in young men.
Conclusion
This was a case where I took medication to treat my back pain, but it only slightly reduced the pain, and I thought the side effects might have been more severe.
As a medical professional, it is obvious that we must not only improve the pain and functional limitations of the symptoms we are managing, but we must not forget the effects on other organs as well! This was something that I learned again.
We have to keep in mind that side effects can be reported at any time.
