From the Research
The next step for a young man with back pain, high CRP (C-reactive protein), and normal X-ray should be an MRI of the spine to evaluate for possible inflammatory conditions or infections not visible on X-ray. While waiting for the MRI, prescribe appropriate pain management with NSAIDs such as naproxen 500mg twice daily or ibuprofen 600mg three times daily with food. Consider a short course of muscle relaxants like cyclobenzaprine 5-10mg at bedtime for associated muscle spasm. The elevated CRP suggests inflammation, which could indicate conditions like ankylosing spondylitis, discitis, osteomyelitis, or other inflammatory arthropathies that X-rays often miss in early stages, as discussed in the study by 1. Blood cultures should be obtained if infection is suspected, particularly if the patient has fever or risk factors. Additional laboratory tests to consider include HLA-B27 (for ankylosing spondylitis), complete blood count, and erythrocyte sedimentation rate, as these tests can help identify underlying inflammatory conditions, as noted in the study by 2. Depending on MRI findings, referral to rheumatology, infectious disease, or spine surgery may be necessary. Advise the patient to avoid activities that worsen pain but encourage gentle movement as tolerated to prevent deconditioning. It is also important to consider the patient's overall health and potential risk factors, such as weight gain, which has been associated with increased CRP levels, as seen in the study by 3. However, the most recent and relevant study, 4, highlights the importance of considering insomnia as a potential comorbidity in patients with chronic low back pain, and screening for this condition may also be beneficial. Overall, a comprehensive approach that includes imaging, laboratory tests, and consideration of potential comorbidities is necessary to properly manage this patient's condition.