P042 Pain therapy – mandatory caution, expected benefit. A case report

Background and Aims Low back pain (LBP) means chronic pain which is the most common diagnosis in pain therapy.In 90% of cases of non-specific etiology and with serious pathology in the background only about 1%.Methods A 53-year-old man presents to the pain therapy outpatient clinic due to chronic progressive LBP for the past 6 months refractory to conservative therapy and procedures.MSCT LS of the spine attached, reduced space of L4-L5 intervertebral discs and biconcave reduction of L5 vertebral body height.Without accompanying comorbidities,well-controlled hypertension,smoker.The nature of LBP directed us to epidurolysis as a modality of pain therapy,an L4/L5 epidural block was initially performed (Chirocaine 0,20% 10 ml with adjuvants).The pain in the spine, hips and down the legs subsided.After four days the patient comes for a check-up and states that the LBP is resolved but that he feels pressure above the pubic bone,heaviness and the need to urinate frequently.EHO of the abdomen was performed,AA dilatation was observed and MSCT was indicated AA infrarenal maximum width up to 63–57 mm with expansion into the right iliac artery which is aneurysmally altered 48–33 mm in length of 45 mm.AA wall with old dissection partially calcified thrombosed with acute dissection and intraluminal hematoma.Emergency vascular surgery was performed,an open repair of the infrarenal segment AA with a bifurcation graft on the iliac arteries was performed.Perioperative course without complications, one month after the operation, the vascular status was normal and there was no LBP.Results Pain therapy as a therapeutic procedure is sometimes also a differential diagnosis because of that it is crucial to recognize the clinical manifestations of LBP and take comprehensive history to rule out another pathologies under LBP.Conclusions The present case highlighted that those common presentations such as LBP can be indicative of serious underlying pathology where timely diagnosis improves prognosis and survival.Pain therapy must be safe and secure.