Illustrative case history

The patient. John R, aged 47, bus driver.

Disease-centred problem. Low back pain for 5 months, after sudden onset of left sciatica (now settled)

Fig. 11.1 Mr JR: site of low back pain and illustration of painful limitation of movement on direction of movement diagram

Yes—lifting a large suitcase out of the bus.

Low lumbar—central and unilateral (left), left buttock.

Dull ache (severe at times). Has changed from a throbbing burning pain to a deep ache.

Present after sitting for long periods and provoked by various activities such as gardening and lifting.

Fluctuates throughout day — better with restricted activity.

Sitting, car travel, coughing and sneezing, soft beds, sex and more strenuous activity.

Back pain analysis

History of injury: Site and radiation:

Type of pain:

Onset: Offset: Aggravation:

Relief:

Associations:

Current management of the problem:

Past history: Family history:

Drug history:

Walking, gentle activity, swimming, massage.

Stiffness in the back, headache, tiredness, insomnia.

Visited another doctor at first, then an allied health professional; referred to a consultant who diagnosed a disc prolapse, and considered surgical removal of the disc was the only appropriate treatment. Patient has 'played a waiting game' and is taking analgesics only.

Haemorrhoidectomy, mild episodes of back pain, appendicectomy.

Non-insulin dependent diabetes, coronary artery disease.

Piroxicam 20 mg daily (prescribed by consultant); OTC analgesics; allergic to penicillin and indomethacin; alcohol—average 4 standard drinks a day; smoking—20 cigarettes a day.

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