Musculoskeletal Case Study
Mr. Alexander French, a 49-year-old truck driver, returns to the pain clinic at 10:30 a.m. accompanied by his wife. His health history includes having been diagnosed with a herniated intervertebral disk at L4-5 about 10 months ago. At that time, he declined surgery and selected the alternative method of treatment, which included wearing a back brace, and home exercises to help strengthen his back muscles. Now his chief complaint is back pain radiating to his left leg. The following is an excerpt from the focused interview.
Interview
Nurse: Good morning, Mr. French. I see by your report you are having back pain again. Your last visit was about 3 months ago for a routine follow-up with no pain.
Mr. French: Yes, that is correct. Yes, to both of your thoughts.
Nurse: First we need to determine your pain level and find a comfortable position for you.
Mr. French: Right now my pain is about 4 on a scale of 0 to 10 and it sometimes shoots down my left leg. It was higher at home but I took my pills before coming here. That's why my wife drove and is here with me. I will be able to sit for a while. When I can't sit any longer, I will tell you.
Nurse: I need more information about the cause, actions you have taken to decrease the pain, and activities since your last visit. Where shall we begin?
Mr. French: I'll start with the cause. I was outside Saturday after it stopped snowing, and I shoveled our front walk. Then I helped the children build a big snowman. I was tired and had a backache that evening, but I tried to ignore it.
Nurse: You ignored it?
Mr. French: I should have taken the medicine right away. I should have had my brace on when I was shoveling and building the snowman with the children.
Nurse: You weren't wearing your back brace?
Mr. French: That's right. I wear it every day to work. I never forget since I move heavy boxes from the truck. I had been feeling so good, no problems, and the snow was not heavy. I guess lifting the second snowball for the snowman did me in.
What were the factors that precipitated Mr. French's re-occurrence of severe pain?
Mr. French c/o severe back pain with radiation to his left leg. When the nurse is interviewing the client, and he c/o pain radiating to his leg, what does this indicate to you?
What recommendations could the nurse suggest to Mr. French?