The Case Files: A Patient with Not-So-Benign Low Back Pain

By Chung, Arlene S. MD; Raukar, Neha P. MD   A 20-year-old man with a history of schizophrenia and polysubstance abuse presented to the ED complaining nonradiating, left-sided low back pain for one week. He denied any trauma, inciting event, intravenous drug use, tuberculosis exposure, or prior history of back pain or surgery. He also denied systemic symptoms such as fevers, sweats, abdominal pain, nausea, vomiting, leg pain, or difficulty walking.   He was taking risperidone and lithium, smoked a pack of cigarettes a day, did not drink alcohol, and occasionally used marijuana. Family history was negative for malignancy. Vital signs remained within normal limits during the course of his visit. Physical exam was notable only for tenderness to palpation over the soft tissues of his left lower back. He had negative bilateral straight leg raises and no appreciable motor or sensory deficits. Plain radiographs of his lumbar spine were unremarkable. Urinalysis was normal, and was specifically negative for blood and nitrites. Erythrocyte sedimentation rate (ESR) was 15 mm/hr. The patient was discharged home with a diagnosis of acute low back pain and a prescription for tramadol.   The patient's next two visits to the ED were for complaints unrelated to his low back pain. He had a CT scan of his abdomen and pelvis for gastrointestinal symptoms, which was normal with no other pathologies identified. The patient was discharged home after both visits.The patient presented nine more ti...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research