Skip to main content
AAPM&R 2025 Main banner
JFK
Final Program


Official Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
On Demand
On Demand
In-Person
In-Person
Livestream
Livestream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Rate ePoster

Pain and Spine Medicine

What's the pain generator?: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Poster Presenter(s)

  • Aaron Wilson, MD

    Resident Physician
    Stony Brook Medicine/University Hospital PM&R Program
    Commack, New York

    • Co-Author(s)

  • BS

    Brett Silverman, DO

    Associate Residency Program Director
    Stony Brook Renaissance School of Medicine
    Port Jefferson, New York

Disclosure(s):
Aaron Wilson, MD: No financial relationships to disclose
Case Diagnosis: The relationship of musculoskeletal and radicular nerve pain.

Case Description or Program Description: 77-year-old man with history significant for low back pain presented with 3-4 months of right posterior knee pain, radiating to the calf, exacerbated by walking and relieved by rest. Initial workup, including knee X-ray and venous Doppler, was negative. Physical therapy provided no relief.

Setting: Outpatient clinic

Assessment/Results: Due to continued symptoms, MRI of the lumbar spine was obtained revealing L5/S1 spondylolysis with grade 1 spondylolisthesis and right L4 nerve root stenosis. Gabapentin was initiated for possible radicular pain. Knee MRI showed small medial/lateral meniscal tears and osteoarthritis. Patient was referred to orthopedics, where he received a cortisone injection, achieving good relief. However, he reported improvement in leg symptoms after starting gabapentin, prior to cortisone injection.

Discussion (relevance): This case highlights the diagnostic challenge of differentiating radicular pain from musculoskeletal knee pathology. The patient's initial presentation mimicked knee pathology, but negative knee imaging and lack of response to physical therapy prompted further investigation. The lumbar MRI findings and improvement with gabapentin, before the cortisone injection, strongly suggests contribution from radicular pain due to L4 nerve root stenosis. While meniscal tears and osteoarthritis may have contributed to his discomfort, symptomatic improvement with gabapentin suggests the radicular component was a major pain driver. This emphasizes the importance of considering spinal pathology in patients presenting with lower extremity pain, even when knee symptoms are prominent. If this patient’s pain was to worsen or simply not improve, one may consider further management including interventional procedures such as epidural spinal injections and/or nerve ablations.

Conclusions: A thorough evaluation including patient history, physical exam, imaging, and other necessary tests will usually reveal the root cause of pain. Identifying the source of pain quickly and accurately is crucial for developing the most effective treatment plan, ensuring appropriate pain control and improved quality of life.