DrVirgo
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Elderly, low back pain, DM, HTN on a CCB,
Straight leg raising produces pain in lumbar area –what does this indicate?
U/A: Leukocytes and epithelial cells.
Diagnosis? Is it lumbar disc herniation?
A. Acetaminophen or C. Methotrexate? Why?
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| khorshid
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Acetaminophen, simple pain killers first. But if we had an option to inject steroids (epidural), would that be the correct option?
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| Justice
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khorshid wrote:
Acetaminophen, simple pain killers first. But if we had an option to inject steroids (epidural), would that be the correct option?
Well, prednisone is on the list, I am choosing it...
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| khorshid
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yes that's what I chose first, but then I doubted it
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| elitoki
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ok~ I chose at first time Prednisone because after no having NSAIDs on the list, I went on second line that is steroid. But after reviewing articles I found that in elderly pt we can use acetaminophe as first line treatment. the back pain should be managed : 1. non pharmacological approch such as physioterapy 2. Acetaminophen or NSAIDs or COX-2 3. TCA 4. raraly is done on elderly the surgery. In this case, patient has clinically sciatic nerve irritation (lasegue sign-pain produced by raising leg) and it could be with any disease such as lumbar disc hernia, piriformis syndrome or just due to osteophyte-(radiculopathy) on the vertebra. He has negative babinski sign that helps to know that the pain is coming from LMN and no in UMN. So, the answer is A) acetaminophen.
Edited by elitoki on 07/24/07 - 04:19 PM
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| dr in trouble
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I am with acetaminophen too---simple analgesics use first
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| Drtweetie
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agree w/ acetaminophen--start simple and adjust from then
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| radonc
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Why would you want to start prednisolone in a 77 yo lady? That is the least favourable choice, in my opinion. Pred has significant SE's.
My answer is also acetaminophen.
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| Justice
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radonc wrote:
Why would you want to start prednisolone in a 77 yo lady? That is the least favourable choice, in my opinion. Pred has significant SE's.
My answer is also acetaminophen.
Well, I am not thinking about pain syndrome but about radicular compromise (the leg test)... This is about herniated disk, so...
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| coolmavs
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I guess elitoki, has given a great explanation as to why Acetaminophen should be given 1st!
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