Case histories
Nerve root pain
Patient: 37-year-old office worker
Five day hx of pain right posterior leg, buttock to ankle, achy in calf, some 'electric shock' like pain down the back of leg, especially when bending over the sink and brushing teeth.
- Has been taking otc co-codamol 8/500, qds some help.
- No bladder or bowel dysfunction - except constipated.
- PMH - left sided L4/5 microdisectomy four years ago - pains the same as then.
- Very worried - requesting private referral to neurosurgeon who operated four years ago.
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Yellow flags patient
Patient: 47-year-old nurse, divorced and lives alone. Involved in looking after mother with mild dementia/restrictive osteoarthritis.
- Four week hx low back ache, constant, some sudden sharp pains with certain movements.
- Started after lifting at work, continued shift then had very sore next day. Took two days off work, immobile at home.
- Been back at work since, but is finding it increasingly painful, especially at the end of shift.
- Going straight to sofa/bed when gets home. Stiff in the mornings - lasting 20 minutes.
- Taking prn ibuprofen 400mg/ paracetamol 1g prn - some help.
- Feels unable to cope with work, asking for time off.
- Not enjoying work for last few years, stressful, not the job it used to be.
- Pmh - mild depression 7 years ago (during divorce), 1 episode of low back pain - 18 months ago - total 6 weeks off work.
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Red Flags
Patient: 72-year-old.
Four week hx of constant deep, achy pain upper lumbar/lower thoracic region. Radiating to right lateral rib cage. HX of fall 18 months previously, nil accident recently. Generally active, walks his dog, paracetemol no help.
