A 34-y.o. female presents with the complaint of a sudden excruciating pain in her back and points to her flank
area on the right side. She rates the pain as 10 on a scale of 1 to 10, with 10 being the worst. She also
complains of nausea with the pain. She states that she has never had anything like this before, and the pain is
subsiding a little now.
What additional questions should you ask the patient and why?
What should be included in the physical examination at this visit?
What are the possible differential diagnoses at this time?
What tests should you order and why?
How should this patient be managed?
Student discussion post to answer to:
The 34-Year-Old Patient Evaluation & Management Plan
Over 100 million Americans are living with chronic pain, and pain is the most common reason that patients
seek medical attention (Crofford, 2015). The assessment and treatment of chronic pain will continue to be
among the most common functions of a healthcare provider. Chronic musculoskeletal pain is one of the most
intractable clinical problems faced by clinicians and can be devastating for patients.
- What additional questions should you ask the patient, and why?
The additional questions I would likely ask are:
• When did your back pain begin?
• Have you ever injured your back?
• Is the pain constant?
• Does the pain affect your ability to function? If so, how much?
• Do you have other signs or symptoms besides back pain?
• Do you do heavy physical work?
• Do you exercise regularly? What types of activities do you do?
• How often do you feel depressed or anxious?
• Do you sleep well?
• What treatments or self-care measures have you tried so far? Has anything helped?
Back pain can range in intensity from a dull, constant ache to a sudden, sharp, or shooting pain ( Worley,
2016). It can begin suddenly due to an accident or by lifting something heavy, or it can develop over time as we
age.
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