Question

JC is a 41-year-old man who comes to the emergency department with complaints of acute low back pain he states that he did some heavy lifting yesterday went to bed with a mile back ache and awoke this morning with terrible back pain which he States as a 10 on a 1 to 10 scale. he admits to having had a similar episode of back pain years ago after I lifted something heavy at work. JC has a past medical history of peptic ulcer disease related to non-steroidal anti-inflammatory drug and said use he is 6 ft tall weighs 265 lb and has a permanent pot belly.
1. what questions would be appropriate to ask JC and evaluating the extent of his back pain and injury.
2.what observable characteristics does JC have that makes him highly susceptible to low back injury?

Answer 1

1-

The questions that can be asked to J.C. in evaluation of the extent of his injury and back pain are listed below.

1. One can ask whether he has difficulty in moving, or is it severe enough to prevent him from standing and other physical activities

2. Does the pain move around to the buttock, upper thigh, or the groin? Does it travel rarely below the knee?

3. Dos the pain tends to be dull and achy?

4. Does he feel local soreness when touched?

2-All serious medical conditions are ruled out, and J.C. is diagnosed with lumbar strain. The nurse practitioner (NP) orders a physical therapy consultation to develop a home stretching and back-strengthening exercise program and a dietary consultation for weight reduction. J.C. is given prescriptions for cyclobenzaprine (Flexeril) 10 mg tid × 3 days only, and celecoxib (Celebrex) 100 mg/day for 3 months. He receives the following instructions: heat applications to the lower back for 20 to 30 minutes four times a day (using moist heat from heat packs or hot towels), no twisting or unnecessary bending, and no lifting more than 10 pounds. J.C. is instructed to rest his back for 1 or 2 days, getting up only now and then to move around to relieve muscle spasms in his back and strengthen his back muscles. He is given a written excuse to stay off work for 5 days and, when he returns to work, specifying the limitation of lifting no more than 10 pounds for 3 months. He is instructed to contact his primary care provider if the pain gets worse.