A 28-year-old woman with radicular pain

Case scenario

A 28-year-old female zoo keeper has increasing pain in her right leg. This has been recurring over the past three years, but the interval between episodes has been steadily decreasing. It is usually relieved by a week’s worth of over-the-counter NSAIDs and a change of work duties. However, the latest episode has required her to take time off work.

No allergies are reported and the only other medication she takes regularly is the oral contraceptive pill. Her past history includes falling from a cantering horse as a young teenager. She has tried pregabalin, but this was not tolerated.

Since the break up of a long-term relationship several months ago, she has gained 6 kg in weight, which is also associated with her current inactivity due to pain.

The patient has undergone an MRI, which showed a disc rupture with protrusion into the right spinal canal at L5-S1. She has been referred to an orthopaedic surgeon, but as she has no private insurance she is on a waiting list for discectomy at a public hospital.

What can be done for this patient now?

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