A more detailed history about the effect of the back disorder on the patient revealed the following:
• humiliation about being on workers' compensation
• boredom and frustration leading to irritable behaviour ('not like me')
• anxious about his future, particularly occupation
• fears of being a cripple 'in a wheelchair'
• conflicts with family members
• concern about reduction of sexual performance
• anger with lack of response from medical management
• anger with lack of interest in his problem
• concerns about something more serious (he admitted to a fear of cancer)
• feelings of depression: unable to cope, sleep disturbance
• concern about taking drugs, especially NSAIDs
Patient-centred physical examination (additional)
General: Tense and anxious man looking older than his years, senile arcus.
Cardiovascular examination: Blood pressure 165/100.
Weight: 85 kg.
Height: 1.67 metres.
Body mass index: 30.5
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