Introduction
Mr. X, a 42-year-old man, appears at a primary care clinic today with complaints of low back pain (LBP) that he has been experiencing since a skiing accident ten years ago. Mr. X has Type 2 diabetes, which is well-controlled with metformin (HGA1c = 5.6). On the recommendation of a friend, he began taking two over-the-counter medications: kava kava for what he calls “anxiety” and CoEnzyme Q10. Mr. X has been a pack-a-week smoker for 15 years. He reports low back stiffness and discomfort with movement, as well as intermittent spasms associated with movement in certain directions. This paper discusses Mr. X’s pharmacological treatment and non-pharmacologic approach, taking into account probable drug-drug interactions and side effect patterns.
Diagnosis of the Patient
Mr. X claims that he has suffered from persistent low back pain since a skiing accident around ten years ago. Sprains and strains of lumbar (lower back) muscles are the most prevalent causes of low back pain. The lower back is prone to muscle strains since it bears the weight of the whole upper body and is engaged in movement, turning, and bending. A lumbar muscular strain is caused by abnormally stretched or damaged muscle fibers. A lumbar strain is triggered by the separation of ligaments from their attachments. Both of these conditions might occur from an acute injury or from prolonged usage. Lumbar strain is thus the most probable diagnosis for Mr. X.
The rationale for the diagnosis of Mr. X’s condition as lumbar strain is based on his clinical presentation. Acute mechanical back strains might be caused by physical or non-physical action, with lifting as the most frequently reported occurrence (Moustafa El Sayed & Callahan, 2022). After moving boxes three days earlier, he felt a pulling feeling in his lower back. The clinical manifestations of a lumbar strain include a lumbar muscular ache or non-specific pain. Acute pain is intense in the first 24 to 48 hours after an injury. For the subsequent twenty-four hours, Mr. X’s pain severity steadily grew. Active spasms and passive stretching of the affected muscle might worsen the discomfort while standing and twisting, hence exacerbating the pain.
Treatment Plan
Non-Pharmacological
All recommendations suggest including a progressive activity and exercise regimen in non-pharmacological treatments. It has been shown that exercise regimens diminish kinesiophobia and fear-avoidance attitudes (Ketenci, 2021). The most popular workout routines are those that target the motor regulation of the stabilizing abdominal muscles. Loss of lumbar spinal stability is seen as a risk factor for the development of low back pain. The transversus abdominis, the innermost abdominal muscle, is crucial for maintaining the lumbopelvic area (Moghadam et al., 2019). Hence, it is believed that reduced activation of this muscle is connected with the incidence and development of low back pain.
The outcome of therapy for low back pain is influenced by psychosocial aspects like pain catastrophizing, the patient’s self-efficacy, and kinesiophobia. In situations when patient education is inadequate to retain mobility and assure involvement in everyday activities, including employment, which are crucial parts of the initial therapy, psychosocial techniques are used. It has been shown that multidisciplinary rehabilitation programs comprising regulated exercise therapy and concomitant medication administration are more successful (Foster et al., 2018). Yet, it should be remembered that manual therapy, craniosacral therapy, physical therapy, exercise, and kinesiotaping also help with pain management and lessen discomfort and phobia of movement.
Pharmacological
Acute low back pain is first treated with nonsteroidal anti-inflammatory medications (NSAIDs) and muscle relaxants. The NSAIDs give some functional enhancement and temporary alleviation of lower back discomfort. Considering the potential for adverse effects (renal, cardiovascular, and gastrointestinal), a number of recommendations support the use of NSAIDs for individuals with lower back pain (Oliveira et al., 2018). It is advised that NSAIDs be taken at the lowest feasible dosage for the shortest term feasible. In addition, myorelaxants are often administered when the myofascial origin of low back pain is suspected, and their combination with paracetamol and NSAIDs is commonly utilized in clinical settings (Oliveira et al., 2018). Patients with acute, frequent muscular spasms accompanied by persistent lower back pain are advised to use these medications for brief durations.
Use of OTC Products
Mr. X utilizes over-the-counter (OTC) medications, such as Kava Kava and CoEnzyme Q10. Kava Kava is a component of the pepper family with psychoactive and pain-relieving qualities, as well as a muscle relaxant activity. At regular amounts, it has been found to aid in sleep, while in lower levels, it acts as a stimulant (Timbo et al., 2018). Due to the danger of weight loss, starvation, apathy, and serious liver diseases such as cirrhosis, hepatitis, and liver failure, the FDA issued a consumer alert about kava dietary supplements (Timbo et al., 2018). Kava may amplify the actions of central nervous system (CNS) depressants like benzodiazepines, which are used to treat sleep disorders or anxiety.
Coenzyme Q10 is a crucial vitamin-like component necessary for the normal functioning of several organs and chemical processes in the body. Coenzyme Q10 should be administered with caution in large dosages to patients with liver disease, bile duct obstruction, or liver dysfunction (Mantle & Hargreaves, 2019). Doses of more than 300 mg per day may influence liver enzyme levels. CoQ10 must be taken with caution in patients on warfarin since it may diminish the efficacy of the anticoagulant. When used as indicated, CoQ10 supplements seem to be safe and have few negative effects. Minor adverse effects may include digestive issues, such as upper stomach discomfort and appetite loss.
Education Plan
Stretching activities, enough rest, and ergonomic exercises must be stressed to patients. Workouts are vital for those with a lumbar strain since they enhance flexibility and decrease muscular stiffness, reducing discomfort and preventing future damage. These workouts may involve hip, hamstring, and back exercises (Ketenci, 2021). It is essential to do stretching exercises properly since poor technique might result in more damage. Rest is also essential for those suffering from lumbar strain. Resting the injured region reduces inflammation and promotes the healing of the tendons, muscles, and ligaments. However, during rest time, it is essential to discourage exercises that may worsen the injuries, including lifting heavy objects or high-impact workouts.
Ergonomic workouts entail modifying one’s work or home surroundings in order to alleviate back strain. This may include employing correct lifting methods, altering overall body posture when seated or standing, and utilizing supporting equipment like ergonomic seats or standing workstations. Ergonomic workouts assist in preventing future injuries and enhancing general comfort. The patient must be educated on the necessity of smoking cessation and given assistance to help them stop. Cessation of smoking may lessen the signs of lumbar strain by enhancing circulation, lowering inflammation, and increasing tissue repair. In addition, cessation of smoking can help in preventing other diseases, such as lung cancer.
Furthermore, Mr. X has a BMI of 27, which is a high value. The normal BMI range is between 18.5 to 24.9, according to the CDC (2022). Thus, it is essential to educate the individual on the significance of weight loss. This may lead to the onset or worsening of lumbar strain. Reducing weight may aid in reducing this extra strain and may lower the likelihood of developing or exacerbating lumbar strain. In addition, weight reduction may enhance general physical fitness by bolstering the core muscles that stabilize the lower back. Moreover, this may help prevent or treat lumbar strain and increase overall fitness.
Conclusion
Mr. X’s most likely diagnosis is lumbar strain. A lumbar muscular strain is caused by abnormally stretched or damaged muscle fibers. Non-pharmacological therapeutic alternatives, such as exercise therapy, physical therapy, and psychological measures, may aid in the decrease of pain. Similarly, pharmacological therapy alternatives, including nonsteroidal anti-inflammatory medications and muscle relaxants, may aid in managing chronic pain.
References
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