Return to Scenario ListShow Learning Points most relevant to Phase 1:

Non-specific back pain

Clinical Discipline(s)/Organ System(s)
General Practice, Musculoskeletal System, Nervous System, Neurology, Orthopaedics
Progress Test Topic(s)
A 50 year old NZ European male presents with low back pain of two weeks duration. His symptoms interfere with his work, personal life and nighttime rest.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Anatomy of the vertebral column and paraspinal structures
   - Pathophysiology of radiculopathy
   - Pathophysiology of pain and pain pathways
   - Physiology of acute and chronic inflammation
   - Physiology of spinal and central mechanisms of sensory perception
Clinical and Communication Skills 
   - Examine a patient with back pain including neurological assessment and joint examination
   - History from a patient with acute and chronic back pain including red flag symptoms
   - Awareness of common causes of back pain
   - Recognise the features of cauda equina syndrome and nerve root compression
   - Interpret lumbar spine X-rays and understand indications for MRI and CT spine scans
   - Management of non-specific back pain; role of the pain service and surgery
   - Assessment of depression, anxiety and alcohol/other drug use
Personal and Professional Skills 
   - Patient autonomy and unconventional treatment
   - Empathise with a patient who has a chronic pain condition
   - Impact of behaviour and views of the health professional on long-term outcome in back pain
Hauora Māori 
   - Under-treatment of pain in minority patients
Population Health 
   - Epidemiology of back pain
   - Impact on health services, including time off work and cost to ACC
   - Employability and sickness benefits - leading to increased deprivation
Conditions to be considered relating to this scenario
non-specific low back pain, lumbar disc prolapse, degenerative disc disease, vertebral fracture, mental health (stress, depression or anxiety)
Less common but 'important not to miss'
cauda equina syndrome, vertebral osteomyelitis, discitis, spinal malignancy, psoas abcess, leaking abdominal aortic aneurysm, pancreatitis
ankylosing spondylitis, tuberculous spinal disease, brucellosis, spinal stenosis, pyelonephritis