The patient reports activity intolerance as a result of the low back pain. What should you include when performing your initial physical assessment?

Observing the patient can help identify any concerns for posture, curves in their spine or asymmetry (Dunphy et al., 2022). Assessment of deep tendon reflexes, strength, sensation of lower extremities, and straight leg raises should be done (Dunphy et al., 2022). Reverse straight leg and Prone rectus femoris test can also help determine the cause of pain (Dunphy et al., 2022). These tests will help identify if there is sciatic nerve involvement or nerve root involvement (Dunphy et a., 2022).

What questions should you ask to appropriately gather this patient’s history?

When the pain started, if it started abruptly or if it was a slow onset of pain. Where the pain in, if it has gotten better or worse since the initial pain, does it come or go or is there all the time. Have you ever had this pain before? If so, did you have any treatment that worked? Any numbness or tingling of extremities. Was their any injury or fall the initiated the pain. Does anything make it better or worse. Gather a number on a pains scale for pain. Is there activities that you are not able to do as a result of the pain. Any bowel or bladder problems? Have you had to miss work because of the pain? (Dunphy et al., 2022).

The patient seems surprised when you begin asking questions about her psychosocial status. Why is psychosocial evaluation important for patients with low back pain?

Chronic pain can be a result of fear, financial problems, anxiety, depression, unhappy with their job, PTSD or poor coping skills which is why it is crucial to ask about this on your assessment (Dunphy et al., 2022) When patients have fear avoidance in can result in less use of their body, leading to further disability which then leads to depression after experiencing pain (Alhowimel et a., 2018).

Concerned that “something serious” is going on, the patient insists of having an Xray to be certain. To warrant an order for an x-ray(radiograph) for acute low back pain (ALBP), what conditions should exist?

Xray’s should only be warranted if after 6-8 weeks of conservative therapy their has been no relief. Other reasons to get an Xray would be if the treatment plan would change based on the patient and their suspected pathology, of if the clinician is worried about fracture, malignancy, infection or progressive neurological deficit (Dunphy et al., 2022).

You inform the patient that most ALBP episodes (almost 90%) resolve within 1-6 weeks and that pain management will focus on symptom control through pharmacological and nonpharmacological methods. What is your plan of care for this patient? Provide full prescription details if medications are ordered.

I would prescribe this this patient Tylenol and Ibuprofen along with heat, rest, and ice. I would also offer this patient the use of a muscle relaxer for short term use.

Tylenol 500 mg tablets – Take 2 tablets every six hours as needed for pain – not to exceed 2400 mg in 2400 hours.

Ibuprofen 800 mg po q 6 hours as needed. Take with food.

Flexeril 10 mg po qhs as needed. Dispense 10 tablets.

I would also refer this patient to Physical Therapy to initiate some stretching and other ways to help deal with the pain.

Other options for this patient would be to use a pool for pool therapy which may be easier to move, yoga, dry needling or acupuncture.

What will you include in patient education and instructions?

The biggest thing to stress to the patient that this will take time to heal. Making sure that they do not go to fast into activities that they could do prior to the back pain in crucial. Staying as active as possible and frequent stretching will help. I would educate them to not do anything that causes more pain. I would educate them to call if symptoms persist, worsen or progress or with interventions no relief in 1 week. (Dunphy et al., 2022).

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