Marked hyperCKemia without acute kidney injury after short-term overlapping analgesic exposure for low back pain: a case report and medication-timeline analysis
Abstract
Abstract Background Low back pain is a common musculoskeletal presentation, and short-term analgesic prescribing often includes nonsteroidal anti-inflammatory drugs, opioid-containing combinations, and adjunctive musculoskeletal medicines. When symptoms and laboratory abnormalities appear after overlapping exposure, total creatine kinase (CK) elevation should not be interpreted as cardiac injury without cardiac-specific evidence. This report describes a young woman with marked hyperCKemia after short-term overlapping analgesic exposure for lumbar pain and illustrates how a medication timeline can prevent over-interpretation of causality. Case presentation: A 27-year-old woman with lumbar pain, myofasciitis, and lumbar disc herniation received outpatient medicines on 2 June 2026, including Panlongqi tablet, Jintiange capsule, and compound codeine phosphate/ibuprofen sustained-release tablets. The confirmed codeine phosphate dose was 39 mg twice daily. She later developed abdominal distension, epigastric/xiphoid discomfort, acid reflux, nausea, palpitations, chest tightness, dyspnea, dizziness, and daytime somnolence/head heaviness. She reported no previous drug allergy, no usual reaction to ibuprofen alone, and that the three medicines were taken simultaneously as labelled, which prevented single-drug attribution from patient history alone. On admission, CK was 1997 U/L, high-sensitivity cardiac troponin I was normal, CK-MB was within the reference interval, creatinine was…
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