Commentary from Sweden

摘要

This patient has a few weeks history of severe pain due to right posterolateral disk protrusion with impingement on the L5 spinal nerve but no signs of cauda equina impact. He also has type 2 diabetes. His pain mechanism, as described, would be mixed nociceptive-neuropathic. There is inadequate pain relief with diclofenac 50 mg three times daily and pregabalin 75 mg twice daily. Prolonged release oxycodone 10 mg three times daily and immediate release oxycodone 10-40 mg as needed is added. However, constipation and straining at stool increases the pain.