Recent-Onset Back Pain and Radiculopathy

20241.1 Case 3B

37-Year-Old Woman with Recent-Onset Back Pain and Radiculopathy

Competent Approaches Demonstrated by Candidates

Initial Consultation

1. Active Listening and Full History
   • Taking a comprehensive history, including the onset, duration, and characteristics of the pain.
   • Exploring the impact of pain on daily activities, work, and quality of life.
2. Psychosocial Factors
   • Acknowledging stress factors such as raising young children, studying full time, and having a partner who is a fly-in, fly-out worker.
   • Assessing the patient’s emotional and psychological state.
3. Forest Plot Interpretation
   • Recognizing that the forest plot indicates a small, statistically significant reduction in pain with surgical intervention.
   • Understanding that pain reduction is stronger in the short term and diminishes in the long term.
   • Concluding that these changes are unlikely to be clinically significant.

Management Plan

1. Exploration of Patient’s Experience and Preferences
   • Discussing the patient’s personal experience with the illness.
   • Understanding the patient’s social circumstances and feelings towards surgery.
   • Exploring the patient’s expectations and preferences for treatment.
2. Alternative Management Options
   • Providing information on non-surgical treatments for acute low back pain and radicular leg pain, such as:
     • Physical Therapy: Exercises and manual therapy.
     • Medication: NSAIDs, analgesics, and neuropathic pain agents.
     • Lifestyle Modifications: Ergonomic adjustments, weight management if applicable.
     • Other Interventions: Corticosteroid injections, acupuncture, chiropractic care.
3. Follow-Up Plan
   • Scheduling regular follow-up appointments to monitor the patient’s progress.
   • Adjusting the management plan based on the patient’s response to treatment.

Common Pitfalls to Avoid

1. Inadequate Psychosocial History
   • Failing to acknowledge the stress of raising young kids, studying full time, and having a fly-in, fly-out partner.
2. Unstructured Consultation
   • Being distracted by the article and neglecting other essential aspects of the consultation.
3. Assumptions and Lack of Inquiry
   • Making assumptions about the patient’s history instead of asking detailed questions.
4. Inappropriate Follow-Up
   • Failing to provide a clear and appropriate follow-up plan.
5. Data Interpretation Issues
   • Inability to interpret the forest plot data or providing incorrect information.
   • Advising to check with a supervisor or fabricating information.
6. Redundant Solutions
   • Offering solutions already attempted unsuccessfully by the patient (e.g., regular paracetamol).
7. Statistical Jargon
   • Using statistical or medical jargon without explaining it in patient-friendly terms.
8. Irrelevant Recommendations
   • Discussing weight loss without knowing the patient’s body mass index or if it’s relevant.

Conclusion

• Summarize the forest plot data and its implications for the patient’s decision regarding surgery.
• Emphasize a patient-centered approach, considering the patient’s unique circumstances and preferences.
• Provide a balanced view of both surgical and non-surgical treatment options, highlighting the importance of informed decision-making.