Patient case (clinical description): A 57-year-old man comes to the emergency department due to constipation.  His last bowel movement was 2 days ago. He complains of spending about 30 minutes once attempting to defecate. He also has lower back pain.  There is no history of trauma. The pain is not relieved with over-the-counter pain medications.  His vital signs are within normal limits.  Examination shows low back pain that is worse with back flexion and raising of the legs; it radiates into his left leg.  Pinprick in the perianal area does not cause rapid contraction of the anal sphincter.  The rest of the neurologic examination is normal. He is suspected of Cauda Equina syndrome and referred to a spinal MRI.

Patient's own account: I'm a 57 year-old-man, and I had to go to the ER because I couldn't go defecate. My last trip to the toilet was 2 days ago, and I tried too many times, during 30 min, to get my poop to get out. I also have terrible lower back pain. The doctor did not notice any trauma. I tried to get the pain away using over-the-counter medications, but it simply did not work! Back in the ER my vitals were normal. My pain was even more intense with back flexion, and when I raised my legs, it radiated into my left leg. The doctor did an anus exam where he had to pinch it and it was not reacting! However the rest of my neurologic exam was normal. The doctor suspects a Cauda Equina syndrome and referred me to a spinal MRI.

Clinical trial: NUCYNTA (Tapentadol Immediate Release) Versus Oxycodone Immediate Release in the Treatment of Acute Low Back Pain

Eligibility criteria:
Inclusion Criteria:

          -  At Visit 1 (study entry) patients must have a medical history and physical and
             neurological examinations that support a clinical diagnosis of acute low back pain
             that is felt down to the lower leg below the knee with the onset no longer than 30
             days before Visit 1

          -  At Visit 1 patients must report qualifying pain intensity scores

          -  Patients must be appropriate candidates for treatment with oral opioid pain medication
             in the investigator's clinical judgment

          -  Patients must be able to appropriately verbalize pain characteristics and to complete
             all protocol required measurements/assessments without assistance

          -  Patients must be medically stable on the basis of physical examination, medical
             history, vital signs, and clinical laboratory tests performed at screening

        Exclusion Criteria:

          -  History of back (cervical, thoracic or lumbosacral) pain =50% of the time in the 1
             year prior to the first visit

          -  History of any low back pain episode, with the exception of the current acute low back
             pain episode, within 3 months prior to the first visit that was greater than mild in
             pain intensity, or was associated with disability (e.g., loss of time from work,
             family, or activities of daily living), or necessitated the use of an opioid
             (narcotic) analgesic including tramadol

          -  Medical history or physical examination results that suggest the acute low back pain
             or any of the neurological symptoms or signs are caused by a serious medical condition
             (e.g., fever, chills, unexplained weight loss, bowel or urinary bladder dysfunction or
             incontinence, bilateral leg weakness, progressive weakness, paralysis)

          -  There is a high probability for surgical intervention for the back pain during the
             projected time on the study or that there will be an increase in the severity of the
             leg pain or deficits

          -  Had either a surgical procedure involving the spine or intervertebral discs in the
             lower back region within 1 year prior to Visit 1 or had >1 surgical procedure(s)
             involving the spine or intervertebral discs in the lower back region

          -  has any painful condition that could interfere with the study assessments or with the
             patient's ability to differentiate the pain associated with the acute low back pain
             episode from pain associated with another condition

          -  History of severe lumbar spinal stenosis, fibromyalgia, or ankylosing spondylitis

          -  history of epilepsy or recurrent seizures

          -  Unable or unwilling to discontinue all prohibited medications at the time of
             randomization and during the time of their participation in the study

          -  Known or suspected history of alcohol or drug abuse based on medical history, physical
             examination, urine drug screening, or the investigator's clinical judgment

          -  History of cancer malignancy within 2 years prior to the first visit, with the
             exception of basal cell skin carcinoma

          -  Have filed or plan to file a worker's compensation claim for any issue related to the
             current acute low back pain episode

          -  Currently involved in litigation or plan to seek legal recourse for any issue related
             to their acute low back pain

          -  Known allergies, hypersensitivity, or intolerance to tapentadol or the comparator
             (oxycodone) or any excipients used in their manufacture

          -  Had previously been enrolled in a tapentadol clinical study

          -  is pregnant or are breast-feeding
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.


Eligibility (NLI label): Contradiction