Back pain Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Takes a focussed history including features of the pain:
Previous episodes
Site - “where is the pain?”
Onset and duration - “when did it start?”, “was this sudden or gradual?”, “how long did the pain last for?”
Character - “how would you describe the pain?”, “is the pain constant or intermittent?”
Radiation - “does the pain move anywhere apart from your chest?”
Associated symptoms (RED FLAGS) - “did you get any:
- Loss of sensation when wiping your bottom*
- Muscle weakness in your legs or arms*
- Incontinence either urine of faecal (indicates loss of control of spinchters)*
- Unexplained weight loss*
- Night sweats?”*
Timings - “does the the pain come on at particular times of the day?”
Exercabating/relieving factors - “does anything make the pain better?”, “have you tried anything for the pain?” “does anything make the pain worse?”
Severity - “how would you rate the pain on a scale of 1-10, with 1 being very little pain and 10 being excruciating pain?”
PMH
“Do you have any medical conditions? Have you ever been treated for any cancers in the past?”
DH
“Have you been prescribed any medications by your doctor? Are you taking any over the counter medications?”
Allergies & reactions - “do you have any allergies to any medications?”, “What happened when you took that medication?”,
(G if includes medication side effects) - “Did you have any side effects to any medications?”
FH
“Does anyone in your family have any medical conditions like back pain, arthritis etc?”
SH
Alcohol, smoking, recreational drugs (including IVDU) - “do you smoke?”, “how much do you smoke each day?”, “how long have you smoked for?”, “have you ever smoked? How much did you smoke and for how long?”(if the patient said they don’t smoke),”do you drink?”, “how much/what do you drink each day?”, “do you use recreational drugs?”, “have you ever injected drugs or shared needles with other people?”
Occupation - “do you work?”, “what do you do for work?”, “how is the back pain affecting you at work?”
Home situation - “what’s your home situation like?”, “do you live with anyone else?”, “do you need help with things like cooking, washing/cleaning yourself?”, “how is the back pain affecting things at home?”
ICE
Ideas - “what do you think could have caused your back pain?”
Concern - “is there anything that your worried about regarding your back pain?”
Expectation - “what were you hoping we would do for you today?”
Examination
Asks to examine patient and briefly describes examination (e.g. “press lower back and examine legs”)
Counselling
Reassures no evidence of serious underlying disease and that a scan isn’t indicated at this point - “from what you’ve told me so far, there are no red flag signs to show that there might be a sinister or dangerous cause for your back pain”
Explains back scans often show abnormalities that aren’t relevant or serious but can create anxiety - “I understand why you’ve asked for an MRI, but often MRI may show abnormalities that aren’t very serious and relevant to the symptoms you’re having and may actually cause more anxiety and I would hate to see you getting anxious, especially with everything that is going on right now and you being the primary carer for your mum.”
(NB. Most GPs don’t have access to MRI scans without referral) - “Also before we can get the MRI scan I’d have to refer you, and you could be waiting up to a month to get it done, as we don’t actually have MRI scanners here in the GP surgery”
Emphasises the importance of an active lifestyle and maintaining a healthy weight (e.g. walking and swimming) - “Going forward, we would strongly recommend doing more exercise and maintaining a healthy weight as this will help with the back pain you’re having.”
Considers manual therapy (Physiotherapy, Osteopathy or Chiropractic) but only as long as package includes exercise. (NICE 2016) - “we could also refer you on for physio or osteopathy, but only if the package includes exercise also”
Recognises patient’s role as a carer and suggests arranging help to look after mother (e.g. social services or voluntary) - “I understand that you’re the primary carer for your mum. Perhaps we could look at arranging support to help to look after your mum. Is this ok with you?”
Recommends ergonomic assessment of work station/advice with lifting - “It’s also important that when your working at the desk you maintain a good posture and consider standing up from time to time. Also, for now we would advise that you stay away from lifting heavy objects”
Suggests “self-help” remedies: Hot & Cold Packs, Hot Baths, OTC rubs - “Another really good thing to do could be using hot and cold pack on the areas that are sore, having a nice hot bath and using creams that you can get over the counter like deep heat to help with the pain.”
Consider STOP ibuprofen and START naproxen (consider PPI). Ensure taken with/after food
Safety-netting
“If you notice any sudden muscle weakness, incontinence, loss of sensation when your wiping your bottom after using the toilet, or any unintentional weight loss or night sweats it’s important that you come back to the GP surgery urgently or go to A&E for medical help”
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is NHS choices, which I’ll right on a piece of paper for you to take home with you.”
