From the Guidelines
The patient should be managed conservatively with a focus on pain management, physical therapy, and further diagnostic workup to rule out underlying conditions that may be contributing to his symptoms, as recommended by the American College of Physicians and the American Pain Society 1. The patient's symptoms of bilateral nerve pain, numbness, and tingling in his legs and feet, particularly when lying down, suggest a possible radiculopathy or spinal stenosis, which warrants further investigation.
- The prescribed medications, ibuprofen 200 mg and acetaminophen 325 mg, are appropriate for pain management, as they have proven benefits in conjunction with back care information and self-care 1.
- The decision to order laboratory tests, including HDL cholesterol, complete blood count, thyroid function tests, and B12 levels, is also appropriate, as it will help rule out metabolic or nutritional factors that could contribute to his symptoms.
- Given the patient's history of B12 deficiency, it is particularly important to monitor his B12 levels, as a deficiency can cause neurological symptoms that might compound his disc-related symptoms.
- Physical therapy has been prescribed to improve strength and mobility, which is in line with the recommendation to advise patients to remain active and provide information about effective self-care options 1.
- A follow-up appointment is scheduled in 30 days to review laboratory results and assess treatment response, which will help determine if the conservative management approach is effective or if further diagnostic testing, such as magnetic resonance imaging or computed tomography, is needed 1.
From the Research
Patient Management
- The patient is being started on conservative management for low back pain, with a plan to review labs in 30 days.
- The patient's symptoms include bilateral nerve pain, numbness, and tingling in the legs and feet, which worsen at night.
- The patient has a history of B12 deficiency and has been treated with B12 injections.
Medication Management
- The patient is being prescribed ibuprofen 200 mg (2T TIDPRN) and acetaminophen 325 mg (2T TIDPRN) for pain management, as seen in a study comparing the efficacy of acetaminophen plus ibuprofen versus acetaminophen plus codeine plus caffeine after outpatient breast surgery 2.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may have variable effects on thyroid test results, with some studies showing no changes in thyroid hormones or TSH 3, 4.
Laboratory Tests
- The patient will undergo laboratory tests including complete blood count (CBC), which can be useful in assessing cardiovascular and metabolic diseases 5.
- Other tests include CHEM HDL, T3, T4, TSH, and B12 to monitor the patient's condition and potential effects of medication on thyroid function.
Follow-up
- The patient is scheduled for a follow-up appointment in 30 days to review laboratory results and assess the effectiveness of the current treatment plan.