In this week’s Clinical Decision, a 50-year-old bus driver comes to you with a 4-week history of pain in his left leg and lower back. He describes a combination of severe sharp and dull pain that originated in his left buttock and radiated to the dorsolateral aspect of his left thigh, as well as vague aching over the lower lumbar spine. After the first visit, you prescribe 150 mg of pregabalin per day, which is gradually increased to 600 mg daily because the symptoms had not abated.
Ten weeks after the initial onset of his symptoms, he returns for an evaluation. The medication has provided minimal alleviation of his sciatic pain. You discuss options for the next steps in managing his sciatica, but he is uncertain about invasive procedures such as lumbar disk surgery even though he feels limited by his pain.
What steps should you take next? Read the opinions, share your comments, and vote now!
Clinical Decisions are a great way to help you evaluate treatment options and gain insight from colleagues. The articles include a case vignette, plus clinically acceptable management options, each supported in a short commentary by a respected clinician. You are invited to vote for, and comment on, the options at NEJM.org, where a diverse range of thinking is presented. Browse more Clinical Decisions articles here!