A patient with lower back pain and right-sided sciatica has taken an NSAID and a TCA for 1 week. The patient reports some decrease in pain but is experiencing increased tingling and numbness of the right leg. The primary care NP should:
a. order a magnetic resonance imaging (MRI) study.
b. order physical therapy.
c. refer the patient to a neurologist.
d. continue the TCA for 1 more week.
A
Acute episodes of low back pain should be treated with an analgesic for 1 to 2 weeks. A muscle relaxant is used to treat spasms. Patients with sciatica should be treated for 6 weeks. If a neurologic deficit progresses, MRI should be ordered. Physical therapy is not indicated until serious injury is ruled out. A neurology consultation is necessary in urgent conditions and conditions with bilateral neurologic findings. The TCA may be continued, but the progression of symptoms necessitates radiologic evaluation.
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