Spinal Infection: A Case Study

HISOTRY OF PRESENT ILLNESS: This 40-year-old Latin female presents with complaints of low back and right leg pain she said that she hurt her back in a motor vehicle accident three years ago and she has had a history of intermittent low back pain since that time. Last December she started a job where she had to lift boxes that weighed approximately 40 pounds. Around the first of January this year she began to complain of back pain that

Range of motion shows flexion of 85 degrees, extension of 30 degrees, and lateral tilt of 25 degrees bilaterally. Straight leg raise is positive on the right at 90 degrees for low back pain. Bechterew's test is positive on the right. The patient has diminished sensation in the right L4, L5 and S1 dermatomes. Deep tendon reflexes are absent in the right knee and right ankle.

Per the medical report dated 07/18/16, patient is being seen for her lower backache, rated 7/10 with medications and 10/10 without medications. Current medications include Ambien 10mg; Maxalt-MLT 10mg; Norco 10/325mg; Evzio 0.4mg; orphenadrine 100 mg and gabapentin 600 mg.

10/30/15 Medical Evaluation reported neck, low back, and left sacroiliac pain. Physical examination of the lumbar spine revealed decreased ROM on

Current medications include Dilaudid 4 mg one tablet every 6-8 hours as needed for pain, ibuprofen 600 mg one tablet twice daily, Lexapro 10 mg 1-2 tablets daily and MS Contin 15 mg one tablet twice daily.

The patient is a 72 year old female. She has been experiencing progressively worse pain and stiffness in her joints. She is reports that she is having decreased range of motion, redness, and swelling in her joints. She is reports symptoms occur in the same joints on both sides of her body. She is also reporting the symptoms are worse when she first wakes up in the morning.

The main concern of Mrs R is chronic pain related to bone pain due to bone cancer with metastatic cancer in the liver as evidenced by the presence of verbal and behavioural indicators of pain such as anxiety, concerns and tension, grimacing, complaints when ambulating with a walker and a pain level of 8/10 at 8:00am.

Pain medicines called opiate analgesics. Some of these are codeine, demerol, Percocet (Oxycodone), Tylenol #3, Tylox, Oxycontin, Percodan, Fentanyl patch, morphine, Methadone, Vicodin (Hydrocodone), and Ultram (Tramadol).

Narcotics. If your pain doesn't improve with over-the-counter medications, your doctor may prescribe narcotics, such

Non-narcotic analgesics are the household drugs used to treat moderate pains. These include paracetamol, aspirin and ibuprofen. There are very few noticeable effects beyond treating specific pains (in contrast to narcotics, when a feeling of well-being takes over the body).

4.) Acetaminophen-Oxycodone (Trade Name: Percocet 5/325) 1-2 tablets by mouth, every four hours; used for decreasing pain as well as decreasing a temperature (Deglin & Vallerand, 2007).

It is especially common to a hospital patient with a present existence of different infection.

Opioids are prescribed to treat moderate- to-severe pain following surgeries, individuals with chronic pain, cancer patients, or for dental pain. These drugs alter the perception and response to pain by binding to opiate receptors on the white blood cells surface or neurotransmitters in the central nervous system (CNS) (F. A. Davis Company, 2009, p. 97). Opioids suppress the CNS and produce a feeling of well-being or euphoria. Opioids

From our clinical expertise, we discourage the use of opioids, for the potential risk of opioid-induced-hyperalgesia (64), dependency and possible addiction (65). Nixdorf et al., suggest to follow the NICE guidelines (National Institute of Health Care and Excellence) for the treatment of peripheral neuropathic pain: oral medications, topical when practical and avoid irreversible treatments that involve local injury (29).

Last Examinations: Last examination 2 weeks ago, general check up, told “normal”. Yearly clinical breast examination (CBE), mammography, told “normal”. Yearly Pap smear, last performed January last year, 2010. Last visit to oncologist, 2008, told “normal”.