Dr. Puri Divya Inder
Rheumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 33-year-old unmarried male, and I have had a back stiffness problem for more than three years. Everyone gives says that my posture is not proper while walking. Two years back when I consulted a doctor, he suspected ankylosing spondylitis, but HLA-B27 was negative. After seeing the x-ray, the doctor told that there are some fusions between the bones. He recommended a few vitamin tablets for a few months, and he asked to do exercise. So, I started swimming, but for the last six months, I am not able to continue because of my job transfer. In the last two years, the condition did not worsen, but the stiffness remains the same. So, I consulted another doctor, who took an x-ray, MRI scan, blood test, ESR, etc., and I have attached my test report. The doctor told me this is neither spondylitis nor arthritis, and he asked me not to worry. If it is ankylosing spondylitis, then it would have gotten worse in the last two years. He said that there is only mild fusion at present. So, he recommended some calcium tablets and Gabapentin tablets. I read a lot of negative reviews on this tablet, in relation to nerves. I am taking this for the last month. I would like to know your opinion on the following, what is the actual condition and seriousness of this problem? Currently, I am having stiffness and posture problems. Will it affect me more in the future? Can I take a Gabapentin tablet? Is there any solution to improve my posture? I have got some suggestions to use hot and cold therapy, can I do it?
Hello,
Welcome to icliniq.com.
I have seen the attached reports (attachment removed to protect patient identity). The diagnosis of ankylosing spondylitis is a clinical and radiological diagnosis. The clinical criteria are a history of inflammatory back pain, and the pain is worse in the mornings and nights. The pain gets worse with rest and gets better with exercise, significant morning stiffness lasting more than half an hour, night pains, awakening in the second half of the night, significant relief of pain with NSAIDs, etc. or MRI of the SI (sacroiliac) joint is the sine qua non for this disease, Sacroiliitis on x-ray or MRI of the SI (sacroiliac) joint is the sine qua non for this disease, as 20 % of people may be HLAB-27 negative and still have AS (ankylosing spondylitis). Gabapentin is frequently given for back pains of non-inflammatory type mechanical back pains, and it is generally a safe medicine. Your posture can definitely be improved with aerobic and back-strengthening exercises, which should definitely be continued. Hot and cold packs are fine for symptomatic relief. I suggest you repeat an MRI of your SI joints, to look for sacroiliitis, this should give us a solution.
Thank you.
Patient's Query
Hi doctor,
Thanks for your reply. Regarding the Gabapentin tablet, I have erectile dysfunction. I got confirmation that this tablet causes ED problems. Is it advisable to stop the medication suddenly or reduce the dosage gradually? The appointment with my doctor is only next month, and I am not able to contact him since he is on vacation. To what extent does this medicine cause this problem? Will it get normal after the medication is over?
Hi,
Welcome back to icliniq.com.
If you have erectile dysfunction, then I would advise you to gradually reduce Gabapentin, as this is not an essential medicine. You can get the same response with exercises to strengthen the back.
Thank you.
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Rheumatology
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