Case Study: Assessment PAIN5002: Introduction to Pain Management

Case Study: Mr Jones

Frank Jones is a 48 year old man presenting with low back and left leg pain.

History

Mr Jone was working as a motor mechanic when lifting a heavy piece of machinery

weighing 35 kg (77 lb) on 5 March 2002. He felt something “give” and had

immediate onset of pain in the low back. He was seen by his local doctor and given

antinflammatory medications and told to take 3 days off work. There was no

neurological deficit and X rays of his lumbar spine failed to find any abnormality.

He requested several more days off work and then returned to work one week after

the injury. Any lifting caused an increase in his pain and after consultation with his

local doctor he was placed on light duties. He returned to work and was given office

duties but his boss made it clear that he was not welcome at work if he could not

return to what he was doing before. He was very dissatisfied doing paperwork.

Eight weeks later his pain had largely resolved and he was cleared by his local

doctor and allowed to return to normal duties. Three months later when he bent over

to pick up his tool box he experienced pain in his back and a shooting pain down his

left leg.

He returned to the local doctor who requested a CT scan. This showed a left

posterolateral L4/5 disc protrusion that was impinging on the left L5 nerve root.

He was refered to an orthopaedic surgeon who advised an L4/5 discectomy.

Following surgery, he had good relief of the leg pain although not the back pain and

despite attempts to return to work found it impossible to carry on. He was dismissed

from his job at the mechanical workshop six months later.

He now spends much of his time at home and twelve months following surgery

began to experience constant burning pain in the left leg below the knee. He now

has continuing pain in the low back and left leg.

Mr Frank Jones – Case Study: Assessment PAIN5002: Introduction to Pain Management

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Previous intervention

ƒ Physiotherapy (prior to surgery)

ƒ Dec 2002 – Surgery – L4/5 discectomy

Pain

Low back

ƒ Constant aching pain with intermittent stabbing pain with activities

ƒ Worse when sitting or standing for long periods, bending, lifting

ƒ Relieved by lying down, changing position, heat

Left leg

ƒ Constant burning pain particularly over outside of left lower leg and top of left

foot

ƒ Worse at the end of the day

ƒ No relieving factors although better when distracted

ƒ Pins and needles down outside of left leg to foot, numbness over top of foot

ƒ Leg gives way from time to time

ƒ No change in bladder or bowel function

Medications

Current

ƒ oxycodone 5 mg 10-12/day – some relief

ƒ sodium valproate 800 mg/day – not sure if helping

ƒ temazepam 1-2 most nights

Previous

ƒ tramadol, amitriptyline (25 mg nocte) – both gave side effects

Medical history

ƒ Hypertensive – on medication

ƒ Weight gain 15 kgs over last 2 years

Psychosocial history

ƒ Married three children 26, 24, 22 – youngest still at home

ƒ Motor mechanic until discharged from last position, seven years in last

position

ƒ Doesn’t smoke – ceased 10 years ago

ƒ Alcohol – 6-8 cans beer on weekends

ƒ Sleep – better with temazepam  but still woken by pain