Mr H is a 62-year-old man with a complex medical history, including chronic lower back pain. He presented to Pain Clinic with worsening pain. He had previously experienced significant symptomatic relief from lumbar facet joint injections and was keen to have this repeated.
His history includes aortic root dilatation with mild aortic stenosis, an implanted cardiac defibrillator (ICD), asthma, fibromyalgia and osteoarthritis.
Diagnostic medial branch block (MBB) injections and radiofrequency ablation (RFA) were discussed with the patient but he was unkeen to proceed due to the risk related to his ICD. It was agreed to repeat his lumbar facet joint injections.
He contacted the hospital a few days after these were performed with worsening symptoms.
Points for consideration before proceeding:
- What other relevant history or risk factors would you seek?
- What are the possible differential diagnoses for sudden worsening pain post-procedure?
- Which investigations would be most helpful in identifying complications and how urgent are these?
