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Presenting your case

Updated: Jan 25, 2021



Opening statement

"Mrs G is 32 years of age and presents with back pain. Had a spinal fusion 10 years ago that was unfortunately inappropriately treated for many years with escalating opiates. There are a number of physical, psychological, and functional barriers that have prevented clinical improvement including deconditioning, depression, and previous abuse. There are facilitators of recovery including motivation to reduce opaites, she is keen to be involved in therapy, and has positive self efficacy."


Pain oriented problem list

"There are several biological, functional and psychosocial issues that I would like to highlight.


Her medical issues are there is ongoing moderate to severe lower back pain following failed back surgery, grade 1 spondylolisthesis with ongoing possible discogenic pain. Contributing is her sacroiliac joint as a pain generator and central sensitisation with likely hyperalgesia possibly secondary to both her pain and her escalating opiate use'.


Her functional issues include deconditioning globally of her lower limbs with a reduced ROM particularly of the hips bilaterally leading to restrictions in her activities of daily living including difficulties caring for her children.


Psychological issues include suicidal ideation without intent and symptoms of depression. She is dependent on opiates, tobacco and benzodiazepines."

  1. Biological/Medical diagnoses

  2. Functional issues and limitations

  3. Psychological issues

  4. Social issues

  5. Vocational issues

Pain history (Time course and LINDOCARRF, pain with medication, function limits, medication history)

"The pain started when she was 18 and had a minor fall. She had Grade 1 spondylolisthesis. She had a spinal fusion and recovered well from surgery at the time. She had minor non-specific pain in her initial pregnancies however her last pregnancy was severe. She has pain that is persistent and chronic focused in the middle of her lower back. Her pain is movement related and worse when standing. There is a shooting and radiating component down both legs but not involving her feet. She displays no symptoms consistent with cauda equina syndrome."


(Or... Clinical diagnoses, Function/disability/general health, patient context)


Pain oriented physical examination

- See blog presentation for this section


Formulation

- Sources of pain

- Predisposing factors

- Precipitating factors

- Aggravating factors

- Relieving factors


- Maintenance factors

- Modifiable barriers

- Unmodifiable factors

- Facilitators for recovery


Management plan

- Medical (Reduce pain, modify activity, blocks etc)

- Physical (Reduce reconditioning, desensitisation, reactivate, ROM)

- Functional (Change ways they can do things (OT style things)

- Psychological/Social (Individual or group therapy/relaxation, confidence, coping, catastrophising, social support networks etc)

- Education/Aims (Stress and pain, acute vs chronic, reconditioning)


Keywords to consider in your presentation:


'He displays maladaptive coping strategies including...'

'Her inability to accept her pain leads to a poor locus of control'

'His passive coping strategies include... his active coping strategies include...'

'She has low levels of self-efficacy demonstrated by...'

'Unhelpful thought processes can be addressed by...'

'Passive treatment reliance could be reduced by...'

'The redirection of solicitous family members and work colleagues could be achieved by...'

'Ultimately return to the workplace could be facilitated and supported by...'

'Education needs to be tailored to the patient by...'

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