We report the case of a 55-year-old patient who was admitted to our chronic low back pain unit for more than 2 years.
The patient had been operated 17 years before for the implantation of a mitral valve prosthesis and since then had periprosthetic leak, with mild hemolysis, treated with iron, folic acid and anticoagulated with anticuar.
The subject reported mild continuous basal low back pain, with a score of 3 on the visual analogue scale, with exacerbations up to a score of 8, predominantly at night and almost daily frequency.
The pain was located in the dorsolumbar area irradiating to the inguinogenital area, more pronounced on the right side, but with bilateral involvement.
The duration of these episodes ranged from minutes to hours, comparing the patient with a burning sensation and sharps.
He showed mild improvement with exercise.
She reported no other symptoms, such as paresthesia or sleep disturbances.
On examination, the patient had no limitation in mobility of the spine, had mild pain on flexion of the negative arch, and non-painful signs of spinous processes.
The trigger points were identified in the squared zone more relevant in muscles corresponding to the right lumbar muscle; the tests for involvement of the psoas and the right sacroiliac joint were positive.
Sensitivity was not affected.
Magnetic resonance imaging (MRI) of the dorsolumbar muscle column reported "polydyscopathy with degenerative changes in L4-L5, L5-S1 (decrease in signal intensity in T2 of the disk discs).
The hemoglobin was 10 g/dl.
The estimated clinical judgment was back pain and low back pain secondary to myofascial syndrome and degenerative polydiscopathy.
Pregabalin, tramadol and paracetamol were given medical treatment; transcutaneous electrotherapy was given.
Corticosteroid tapering and local anesthetic were performed on the trigger points corresponding to the right lumbar square muscle and bilateral lumbar facets; none of the therapeutic measures improved LBP.
The patient was treated with transcutaneous fentanyl and slight improvement was observed.
The subject was reevaluated after 3 months of treatment.
Blood tests showed an increase in hemolysis-measuring parameters: decreased hemoglobin (9.6 g/dl), hemoglobinuria 250 erythrocytes/field, increased echocardiography lactodehydrogenase (LDH 4.806).
The patient was a cardiovascular surgeon and operated on to replace the malfunctioning prosthetic valve.
After the intervention, after one year, the patient remains without low back pain.
