Introduction: The abuse of tobacco and drugs can worsen chronic low back pain.
Clinical case:
56-year-old patient, operated on in 2006 for foraminal stenosis L5-S1. Decompression and bilateral foraminotomy were performed. Since then the evolution has not been favorable since it continues with lumbar pain and rigidity. Medical treatment and rehabilitation were prescribed with sporadic improvements. A new Lumbar Magnetic Resonance was performed, appreciating a disc collapse L5-S1. The patient is told that if they do not improve, a new surgical intervention is necessary to perform the L5-S1 arthrodesis. I n current treatment with Tramadol 50 mg every 24 hours and Lorazepam 5 mg for sleep. Cannabis consumer, rolling tobacco, and occasional alcohol. He goes to the emergency room for an increase in low back pain and insomnia. Since admission, he has been prescribed lormetazepam 1 mg and diazepam 5 mg for sleep, which is being effective.
Diagnosis: Pain poorly controlled. Harmful use of cannabis and alcohol substances currently in remission, without abstinence.
Plan: Maintain psychopharmacological treatment as it is, and control analgesia. Tapentadol 50 mg is prescribed every 8 hours.
Recommendations: Correct habits of tobacco, alcohol and drug use to improve pain control of low back pain
Bibliography
-Chronic lumbar pain. Multidisciplinary assessment of 100 patients. Aten Prim 2000; 26: 97-111.
-Low back pain and alarm symptoms. Semergen 2000; 26: 511-3.
-Criteria for surgical indication of low back pain. Medicine 2001; 8: 1810.

LOW BACK PAIN SYNDROME AND ABUSE OF DRUGS