Low back pain with lumbar subcutaneous edema successfully treated using traditional Chinese medicine, including radix astragali

Abstract

Abstract Introduction: Lumbar subcutaneous edema (LSE) is incidentally found in obese patients during the course of evaluating the cause of low back pain using magnetic resonance imaging (MRI). However, there is no established treatment for LSE, and the mechanism underlying its development is unknown. Patient concerns: A 77- year- old woman presented with chronic low back pain that had persisted for several years. Her BMI was 25.1 kg/m2, which indicates obesity in Japan. Diagnosis: MRI revealed LSE, which extended from the level of the L2 vertebral body to the sacrum. Interventions: We prescribed Maxing Yigan (MYG), a traditional Chinese medicine formula, to which we added powdered cinnamon bark and processed aconite root (hereafter referred to as modified MYG). Outcomes: This treatment was ineffective for six months. We then added Radix Astragali (RA) to the modified MYG. One month later, her low back pain was found to have markedly improved. MRI also confirmed that the LSE decreased remarkably. Conclusions: According to the clinical and MRI findings, modified MYG, including RA, was effective for the treatment of low back pain and LSE. The mechanism underlying the development of LSE could be lymphatic pooling due to perilymphatic inflammation associated with obesity. Modified MYG, including RA, might suppress perilymphatic inflammation and thereby improve lymphatic drainage. Further investigations are required to support this hypothesis.