Chronic non malignant pain and nonsteroid antinflammatory drugs misuse: Nsaid misuse

Abstract

Introduction: Pain is a subjective experience. Perception of the pain intensity is influenced by multiple factors including genetic, socio-economic and psychological factors. Chronic non-cancer pain represents the socioeconomic burden. In adolescent population, osteoid osteoma has an incidence of 10-12% in all symptomatic benign bone tumors. Nonsteroid anti-inflammatory drugs (NSAIDs) are the most frequently used medications for non-cancer pain treatment. Case report: Male, 17 years old, complained about moderate low back pain. Clinical examination was performed and subsequent diagnostic procedures (ultrasound examination of abdomen, nuclear magnetic resonance examination, and radiographic examination of lumbal spine) revealed discopathia and left leg sensory neuropathy. After examination by a pediatrician, physical medicine specialist and an orthopedic surgeon, he started using analgesic (ibuprofen 600 mg), vitamins and physical treatment. Diclofenac 75 mg was added for severe pain management. Haematuria, eosinophylia, decreased creatinine clearance were consequences of NSAIDs toxic nephritis. NSAIDs were stopped and patient reffered to pain specialist - different focuses of pain were suspected. Subspecialist verified pricking and heating sensation in upper leg, severe hip pain without functional deficit and dominating neuropathic pain originating from spinal nerve compression. New radiography reveiled presence of osteoid osteoma of the hip, and after orthopedic consultation, surgery (biopsy of tumor and tumor extirpation) was performed. In the postoperative period, strong pain disappeared, pregabalin was introduced and neuropathic pain was reduced by 20% and low back pain by 30%. Discussion: NSAIDs are the first line treatment of wide range of pain states. NSAIDs can cause numerous serious side effects including acute interstitial nephritis. Conclusion: Multiple causes and types of pain can exist simultaneously, therefore detailed physical examination, followed by other diagnostic Pre primene analgetika, neophodno je izvršiti detaljan klinički pregled i dijagnostičke pretrage, čime bi se smanjila nekritična primena NSAIL.

Keywords

• pain
• neuropathic pain
• functional deficit
• osteoid osteoma
• NSAID
• haematuria