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The back pain problem

Case history 4

A retired Solicitor aged 88 comes to see you. He was widowed 10 years ago, but is of sound mind and in good general health. He is a very keen golfer, who plays and lives locally to you, but also has an apartment in Florida where he goes during winter. He complains of severe back pain spreading into the top of the legs when he walks, and this pain is now sufficient that he has to drive a golf buggy. In the last 3 weeks he has been unable to play more than 9 holes.

He tells you that he lives for his golf, and he wants to get back to it, and if this is impossible his life really isn’t worthwhile continuing with. There is no quality to his life as all of his interests revolve around golf, including his social circle.

Do you

1) certify him as mad?

2) arrange euthenasia?

3) tell him that treatment is inappropriate and he should try to cope?

4) use pain-relieving techniques?

If you choose pain-relieving techniques, what do you think would be appropriate?

1) TENS or acupuncture?

2) non-steroidal anti-inflammatory drugs?

3) analgesics?

4) nerve blocks?

5) surgery?

6) a Pain Management Programme approach?

If you feel that medication is appropriate, what would you consider?

1) Paracetamol?

2) NSAIDs?

3) COX2 inhibitors?

4) Tramadol?

5) Opioid derivatives (eg Dihydrocodeine)?

6) Morphine?

7) anti-convulsants?

8) antidepressants?

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