Tutorial 5: Case 1

Question 1

James is a younger tradesman who has been working. He comes in asking for something for his sore back so he can keep working. He asks, “could I have something for a sore back please?”

A) Who is it for?

B) What are the symptoms?

C) How long have you had these symptoms?

D) Action taken

E) Medications being taken?

F) Medical conditions

G) Allergies

Answer 1

A) Myself

B) Dull ache in lower back

C) Yesterdy afternoon and this morning whilst at work

D) I took some parcetamol tablets this morning but it hasn’t seemed to help

E) No I don’t take any regular medicines. Just the paracetamol tablets which I took this morning.

F) No

G) No

Question 2

Appropriate extended questions

1. Are they any other symptoms (pain elsewhere in the body or weakness)?
2. Describe the pain? Is the pain affected by movement or rest?
3. How would you rate the pain (scale of 1-10 with 0 being no pain and 10 being the worst pain)
4. Have you had this before
5. Has medication helped before
6. How long did pain last in previous episodes
7. Is there a history of injury with the lower back
8. Has anything changed recently? Any activities?
9. Do you prefer a drowsy or non-dreowsy formula?

Answer 2

1. No
2. Aching pain in the lower back region generally there all the time. It seems worse when I am doing sudden movements at work this morning.
3. 4 out of 10, just niggling me at the moment. I need to get back to work so I really need something to help ease the pain so I can continue working.
4. Every now and then, especially after a hard day at work
5. Usually, two paracetamol tablets would do the trick but not this time. I think I also have tried Nurofen in the past when I had no panadol and it seemed to work too, maybe even better.
6. Only 1-2 days at most
7. No, only after a hard day I occasionally experience stiffness or a slightly lower back
8. Actually I was playing PlayStation most of the day yesterday as a new game came out so I sat down most of the day which isn’t usual for me. I think I get a sore back at work after doing that the day before in the pas/t
9. I would prefer nothing that makes me drowsy as I occasionally have to operate machinery whilst at work.

Question 3

What is the diagnosis? Explain reasoning to patient.

Answer 3

Based on the signs and symptoms you have told me, I believe you have acute lower back pain. The pain you are describing in this specific area has confirmed my diagnosis, most likely caused by you sitting down the whole day.

Question 4

What product would you recommend for this patient? Provide IDARL.

Answer 4

Diclofenac (Voltaren gel)

• Indication: Since you have tried paracetamol and it didn’t work, I will give you an NSAID (a non-steroidal anti-inflammatory drug). It will reduce the pain and inflammation in that specific area. It also won’t cause drowsiness.
• Dosage and directions: Massage gently into the affected area 2-4 times daily.
• Adverse effects: Generally well tolerated but may cause skin irritation, itch or rash.
• Duration of treatment, time to recovery, when to refer: try using it for a week, if you still have pain after this, I will refer you to a doctor. Or if the pain radiates to your legs / worsening pain over the next few days.
• Lifestyle/self-care: good posture, take regular breaks to stand + stretch and walk, exercise for at least 30 minutes a day.

I will give you a self care-card for lower back pain and a consumer medication information leaflet. Do you have any questions for me?

HARM

No heat

No alcohol

Reinjury (avoid running or exercise)

No massage