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Case Study Shows Poor Results of Back Pain Overtreatment

Aggressive treatment, narcotic overuse can result in worse pain, loss of function and addiction

THURSDAY, June 3 (HealthDay News) -- For low back pain, overly aggressive surgical treatment and overtreatment with narcotics can result in severely adverse outcomes for the patient, including increased pain, loss of functionality and drug addiction, according to a case report in the May 20 issue of Spine.

Philip D. Parks, M.D., of the Lifespan Corporation in Providence, R.I., and colleagues reviewed the medical records of a 40-year-old male patient who suffered from chronic low back pain, but who had good function. The patient underwent progressive treatments, including nonsteroidal anti-inflammatory drugs, muscle relaxants, steroids, antidepressants and ultimately spinal fusion surgery accompanied by increasing doses of opioids for unrelieved persistent pain. After surgery, the patient's pain, medical and functional status deteriorated, and he was diagnosed with failed back surgery syndrome.

The reviewers conclude that the aggressive surgical approach had been unwarranted, as it was not supported by progressive neurologic signs, radicular findings, evidence of a herniated nucleus pulposus causing nerve root impingement, spinal stenosis, or identification of any pain generator. Further, the prescription of high-dose opiates led to unrecognized opioid-induced hyperalgesia. The patient had to quit work and apply for social security disability benefits. Eventually, the subject also needed to be hospitalized for substance abuse treatment and detoxification.

"This single case review demonstrates the adverse consequences of overly aggressive treatment of chronic low back pain, overtreatment with narcotics, failure to recognize opioid-induced hyperalgesia and iatrogenic addiction, and suboptimal treatment of associated mood problems. For each of these issues, current evidence supports alternative approaches that would have likely led to better outcomes," the authors write.

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