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Stop Chasing the Pain: An Osteopathic Approach to Treating Migrating Pain Caused by Lumbar Radiculopathy- the Importance of Treating the Cause not the Symptoms

Journal: The AAO Journal Date: 2023/06, 33(2):Pages: 22. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/33/2/20/493544/LBORC-NUFA-Poster-Abstracts-2023-Students)

Keywords:

case report [514]
low back [418]
lumbar radiculopathy [3]
male [479]
OMT [2951]
osteopathic manipulative treatment [2973]

Abstract:

Introduction/Background: Radiculopathy initially presents as paresthesia/dysesthesia, motor dysfunctions, and hyporeflexia affecting a specific dermatome or myotome immediately following an inciting event. Radicular pain in patients older than fifty-five is concerning, with gabapentin sometimes used as conservative treatment. Case: A 58-year-old male presented to the clinic with right anterior thigh pain that began 1 day prior as low back pain. Unsure of the inciting event, the patient had difficulty walking and weight-bearing on the right. Physical exam showed a negative Lasegues test with 5/5 muscle strength and 2+ reflexes bilaterally. Treatment focused on quadriceps, iliopsoas, sacroiliac, and lumbar somatic dysfunctions (SDs). Two days later, he returned with 9/10 right suprapatellar burning pain. Lasegues test was now positive, but patient denied any altered sensation. Knee SDs were subsequently added into treatment. Five days later, patient returned with lateral thigh soreness and 5/10 groin pain. At this visit, a diagnostic x-ray revealed grade 1 retrolisthesis of L2 on L3. Results: Prior to treatment, the patient scored 58% on the Oswestry Low Back Pain Disability scale, marking severe disability. After 2.5 months of osteopathic manipulation, including 1 month of physical therapy and gabapentin, he scored 2%, marking minimal disability, and his pain was a 2/10 intermittent twinge. Discussion: At first, the migrating pain was treated as it presented, but as one symptom would resolve, a new one would arise. The confounding pain persisted until we discovered its origin, highlighting the importance of treating the etiology to produce lasting relief. Future research into the effectiveness of osteopathic manipulation combined with gabapentin to treat radiculopathy would be appropriate. A limitation of this study includes the involvement of physical therapy in treatment.


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