What is the best course of treatment for a 26-year-old male with low back pain, disc degeneration, and bilateral nerve pain, with a history of Vitamin B12 deficiency?

From the Guidelines

The patient should be started on conservative management with ibuprofen 200 mg (2 tablets three times daily as needed) and acetaminophen 325 mg (2 tablets three times daily as needed), along with physical therapy to help strengthen core muscles and improve flexibility, as recommended by the American College of Physicians and the American Pain Society 1. The treatment plan for this 26-year-old male patient with low back pain and bilateral nerve pain, with x-ray showing mildly diminished disc spacing at L4-5 suggesting possible disc degeneration, is appropriate as it aligns with the guidelines for the diagnosis and treatment of low back pain. Some key points to consider in the management of this patient include:

• The use of systemic corticosteroids is not recommended for treatment of low back pain with or without sciatica, as they have not been shown to be more effective than placebo 1.
• Nonpharmacologic therapy with proven benefits, such as spinal manipulation, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation, should be considered for patients who do not improve with self-care options 1.
• The patient's history of B12 deficiency is important, as it can cause neurological symptoms, and the ordered laboratory tests, including vitamin B12 level, will help to assess the current status and guide further management.
• The follow-up appointment in 30 days will allow for evaluation of treatment effectiveness and review of lab results, which is crucial in determining the next steps in management.
• It is also important to note that the patient's symptoms, such as numbness and tingling in the legs and feet, especially when lying down, could indicate nerve compression from the disc issue or potentially relate to the B12 deficiency, and close monitoring is necessary to adjust the treatment plan as needed.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Carefully consider the potential benefits and risks of ibuprofen tablets and other treatment options before deciding to use ibuprofen tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals [see WARNINGS] Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain. The patient is prescribed ibuprofen 200 mg (2T TIDPRN), which is a lower dose than the recommended dose for mild to moderate pain. The recommended dose is 400 mg every 4 to 6 hours as necessary for relief of pain. However, the prescribed dose may still be effective for the patient's condition, and it is always best to start with a lower dose and adjust as needed. The patient's response to the treatment should be monitored, and the dose should be adjusted accordingly 2.

• The prescribed dose is 200 mg (2T TIDPRN), which translates to 400 mg three times a day as needed.
• This dose is within the recommended range for mild to moderate pain.
• It is essential to monitor the patient's response to the treatment and adjust the dose as needed to achieve the best possible outcome.

From the Research

Laboratory Tests

• The patient is scheduled for several laboratory tests, including a complete blood count (CBC) 3, 4, 5.
• The CBC test measures various components of the blood, such as red blood cell count, hemoglobin, hematocrit, and white blood cell count and differential 3.
• The test can be useful in monitoring treatments for hematologic disorders and other medical problems, as well as predicting the risk of certain diseases, including cardiovascular disease and metabolic syndrome 4.

Rationale for Laboratory Tests

• The CBC test can provide important information about the patient's overall health and can help inform the plan of care 5.
• In this case, the patient's laboratory results will be reviewed at a follow-up appointment in 30 days to assess the effectiveness of the current treatment plan.
• The patient's medical history, including a previous B12 deficiency, may also be relevant to the interpretation of the laboratory results 3, 4, 5.

Treatment Plan

• The patient has been prescribed ibuprofen and acetaminophen for pain management, as well as physical therapy (PT) 3, 4, 5.
• The patient's symptoms, including low back pain, numbness, and tingling in the legs and feet, will be monitored and addressed through the treatment plan.
• The laboratory tests, including the CBC, will help to inform the treatment plan and ensure that the patient receives appropriate care 3, 4, 5.