Case Study – Lower back pain (LBP)
Mr D is a 56 year old male who has a 5 year history of LBP due to a work injury. His L1 to L3
vertebrae have disc erosion and he is on a waiting list for a lumbar fusion. He has presented to ED
with sudden onset LBP after difficulty getting out of his car. He describes this pain as being across his
whole lower back with a sharp pain down his right leg, radiating distally and posteriorally to the right
foot, stating his pain score is 10/10. The ED team have identified another slipped disc at T12 level via
MRI. His BP is elevated at 188/109 and feet are oedematous.
Mr D is obese with a BMI >42. He eats poorly and takes Bendrofluazide 2.5mg O.D for recently
diagnosed essential hypertension. He is a real estate agent and he lives with his wife and they have
three children, who live out of town. Mrs D has been asking him to cut back in his work as she feels
the many hours driving in the car are contributing to his pain, but he says he cannot due to financial
reasons. He drinks 2-3 glasses of whiskey a night and he says “it takes the pressure off”.
Mr D has been taking Paracetamol and Ibuprofen on and off for the past 5 years and recently the GP
has prescribed him Oxycodone for breakthrough pain. Mr D has been taking 1-2 Oxycodone tablets
10mg q12h and “feels much better” so he stopped taking his BP medication.
Mr D’s goal is to get this new onset pain under control and go home as soon as possible as he waits
for his surgery.
Using the case scenario, write an essay which must include the following:
globally.
⯍ Corbin & Strauss Illness Trajectory Model
⯍ Transtheoretical (Stages of Change) Model (Prochaska & DiClemente)
demonstrate a clear understanding of your chosen model of care.