Case report of neuropathic spinal pain following spinal fixation surgery treated with medication and local injections
History
A 67 year old gentleman was seen in the Pain Clinic. He had undergone a spinal fixation but still had persistent back pain, bilateral buttock and hip pain with sciatica-like pain radiating around bilaterally to the anterior thigh. This was particularly bad when he was standing and walking. He also got some intermittent ankle pain and knee pain. He was taking Tramadol and Celecoxib as required for the pain.
Examination findings
On examination he had extremely severe lumbar facet joint tenderness and sacroiliac joint tenderness, along with right piriformis muscle tenderness. He was started on Pregabalin 75 mg nocte for one week followed by 75 mg twice per day for one week. He was also put on the list for urgent lumbar facet joint and sacroiliac joint injections under x ray guidance.
Medication
This gentleman was seen one month later on Pregabalin 75mg twice per day. He reported that the nerve pain and spasms had entirely gone and he felt vastly improved. In terms of adverse effects, he had a dry mouth but few other adverse effects. We decided to keep him on the Pregabalin 75 mg twice per day for another month and then review him with a view to reducing the dose. He continued with his physiotherapy based rehabilitation and was finding this much more beneficial since he had the reduction in the levels of his pain.
