What is the appropriate management for a 26-year-old male with a history of vertebral fracture, back pain, paresthesia in the right leg, and a palpable breast mass with a family history of cancer?

From the Guidelines

I strongly recommend a comprehensive approach to address the patient's back pain and breast mass, prioritizing further diagnostic evaluation and treatment to minimize potential morbidity and mortality, while also considering the patient's quality of life. The patient's complaint of back pain with tingling in the right leg suggests possible nerve involvement from the previous fracture, and spinal imaging (MRI preferred) should be scheduled to evaluate the previous fracture and potential nerve compression 1. For the back pain, naproxen 500mg twice daily with food for 7-10 days is appropriate, as it has worked well for the patient previously. Regarding the breast mass, an ultrasound should be scheduled promptly, followed by possible mammography and biopsy if indicated, especially given his family history of cancer 1. The patient should be advised about potential side effects of naproxen including gastrointestinal irritation and advised to report worsening neurological symptoms (increased tingling, weakness, or loss of bowel/bladder control) immediately. Key considerations in the management of this patient include:

• The importance of early detection and treatment of potential underlying conditions, such as nerve compression or breast cancer
• The need for a thorough diagnostic evaluation, including imaging and potentially biopsy, to guide treatment decisions
• The importance of patient education and counseling regarding the potential risks and benefits of treatment options, as well as the importance of follow-up and monitoring for potential complications. Given the patient's family history of cancer, it is crucial to prioritize a thorough evaluation of the breast mass, and to consider the potential for male breast cancer, which, although rare, can have significant implications for morbidity and mortality 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Patient's Back Pain and Tingling Sensation

• The patient is experiencing back pain and tingling sensation in his right leg, which may be related to his previous broken back injury 2.
• Naproxen has been prescribed to the patient, which he has used in the past to control his back pain, but its effectiveness in treating back pain after spinal surgeries is limited compared to gabapentin 2.
• Further imaging has been recommended to assess any underlying issues related to the tingling sensation in his leg.

Gabapentin as an Alternative Treatment

• Gabapentin has been shown to be more effective than naproxen in treating persistent pain after spinal surgeries, with a significant reduction in back pain and leg pain 2.
• Gabapentin may be a viable option for treating chronic low back pain without radiculopathy or neuropathy, although more data is needed to support its use 3.
• Gabapentin has also been shown to be effective in reducing neuropathic pain after spinal cord injury, with no significant difference in efficacy compared to pregabalin 4.

Interaction between Gabapentin and Naproxen

• Gabapentin and naproxen can interact synergistically to produce antihyperalgesia, suggesting that the use of gabapentin in low-dose combinations with naproxen may afford therapeutic advantages for clinical treatment of persistent inflammatory pain 5.
• The combination of gabapentin and naproxen may be more effective than either drug alone in reducing thermal hyperalgesia associated with peripheral inflammation 5.

Patient's Breast Mass

• The patient has reported a mass in his right breast, which requires further investigation, particularly given his family history of cancer.
• An ultrasound has been suggested to investigate the mass further, ensuring early detection and appropriate treatment if necessary.