The Perfect Back Pain History | OSCE | UKMLA, PA, ACP, ANP ​​⁠ || Pareto Education

hello it's Camille from par education

and on this video we will be discussing

back pain back pain is an extremely

common presentation and you will see

situations present in both primary care

and also secondary care

settings there are three main causes of

back pain firstly mechanical and

traumatic back pain could there be in

history of trauma or heavy lifting does

the patient have poor back Health such

as a poor posture or sit for extremely

long periods of time are there

associated neurological symptoms such as

shooting pain down one leg this is

typical of a sciatica type picture they

also may present as an acute spasm which

can be very very

painful the second type of back pain is

inflammatory this typically occurs in

young people was their stiffness in the

morning with a reduced range of movement

and do non-steroidal anti-inflammatory

agents help with the pain

thirdly malignancy is there weight loss

or loss of appetite does the patient

wake up in the night with pain is there

any other systemic symptoms any weight

loss for example in prostate cancer this

particularly commonly metastasizes to

the spine so do ask about urinary

symptoms don't forget those all

important red flag symptoms ask about

the following is there loss of sensation

around the perianal private pass area do

does the patient have loss of their

control over their bladder or bowels

known as incontinence do they have any

shooting pains loss of sensation

bilaterally on both of their lower limbs

if these are present you should instruct

the patient to seek urgent attention

with a potential MRI scun warranted

let's see an example of a back pain

history in action hi my name is camil

I'm one of the physiotherapists at the

practice can I take your name and date

of birth please yeah I'm uh Alan Smith

and I'm 4 9 years old so nice to meet

you Alan I can see you're in a bit of

back pain there um is that right that's

probably why they referred you to myself

as a physiotherapist yeah I've got such

terrible back pain um I went to the

receptionist to book an appointment and

they said you know you were available um

I just need some help with it it's so

bad yeah of course we can definitely you

know ask you some questions about your

back pain and probably get to a

diagnosis and a management plan as well

if that's okay absolutely I'm at your

service thank you all right brilliant so

tell me Alan more about this back pain

when did it start what's been happening

well this back Pain's been happening for

the past 3 days okay I'm not sure what's

B it on to be honest it I was fine and

then midday on that day it just started

and since then it's been so bad so so

bad I'm really sorry to hear that so

tell me about the back pain I'll ask

some specific questions about it tell me

about the sight of the back pain is it

upper back middle of the back lower back

I can see holding it's the right side of

my lower back okay and has it always

been like that that's the case it's been

always like that yeah um the thing that

concerns me is the fact that this pain

is not just in my back it's in my leg as

well all right and it feels like the

pain is stretching down from my back to

my leg and is it just the right leg or

both legs just the right leg and has

that been the case since the pain

started pretty much so okay fine um and

you said the pain started 3 days ago did

onset suddenly or was there a gradual

increase in the pain or what happened

around that time well it wasn't suddenly

it wasn't it wasn't like that um I was

fine in the morning I got up made some

breakfast came downstairs I could feel a

bit of a tinge in my back I thought hey

what's going on here and then a few

hours later it just getting worse and

worse and worse and I was doubled over

in pain oh I'm so

sorry it's just terrible I could I could

cry right now I can see that it's quite

severe pain for you most definitely and

I'm really sorry I we'll try and do our

best please to get to the bottom of this

so you said it's it's mainly started 3

days ago and you know like that change

and then it got worse and worse has it

gradually gotten worse or has it stayed

the same it's pretty much stayed the

same okay fine and tell me about the

character of this pain is it a sharp

pain is it a dull pain is it a stubbing

pain is it like an electric type pain

it's an electric pain

okay you know it's like a it's like a

constant shooting down my leg okay from

my back to my leg I'm sounds really

severe that actually I'm telling you I

wouldn't wor I wouldn't wish it on my

worst enemy absolutely and tell me about

radiation so radiation is just a word we

use if the pain travels anywhere I can

see you know traveling to the right leg

is that right yeah just just the right

leg and is it the whole right leg the

back of the leg the front of the leg

it's the back of the leg okay and all

the way down to your feet Yes left leg

absolutely fine brilliant okay and upper

back there's no be no issues no not at

all okay and are you getting any pain or

unusual Sensations around the private

area around the bottom anything like

that nothing at all okay fine and tell

me about some Associated symptoms so he

said it's mainly pain is there any

weakness associated with this no no

weakness but but I do have some numbness

okay you're feeling that area is numb

yes okay and is that associated with the

pain as well just constantly there yeah

I mean I can feel my leg it's just feels

odd I understand yeah so with this pain

this numbness are you having any

problems your daily activities I I can't

move very well you know I normally play

golf I can't swing I can't walk around I

can't sit I can't sit straight I just

can't get comfortable you start with the

pain that's affected it's the pain yeah

and the certain movements make the pain

worse um you know the only thing that I

mean everything makes it worse the only

thing that makes it better is if I was

to lie on my left side okay okay and

just one last question about the leg

especially and the back is there any

pins and needles type sensation not

really no not to the back anything like

that no fine and although the leg is num

you can't feel the leg to touch the leg

you can't feel it okay B so in terms of

exacerbating factors you've said that

walking kind of makes it work activity

is any other like certain movements when

you bend over does that sort of make it

worse anything like that I mean I can't

bend because of the pain yeah I can't

straighten my back because of the pain

yeah I can't do anything okay and tell

me about things that can help the you

know pain has there anything helped pain

relief anything like that I've tried

paracetamol and it's done nothing okay

and I haven't done anything else other

than that right I've tried to kept

moving because that's what I've read

online to try and keep moving but it's

hard absolutely it is yeah definitely so

with this back pain tell me about the

severity of the pain you know you can

use things like mild moderate severe or

you can use a scale of 1 to 10 i' would

say it's a nine nine so severe very

severe okay I have some certain

questions in regards to this we call

these red flag questions they just rule

in or out some serious conditions that I

have to think about when a patient

presents like this so you said you've

got no middle or upper back pain

no okay and when this first happened you

didn't have a fall or there wasn't a

trauma know a sporting injury no nothing

at all no lifting heavy weights no okay

no lifting moving furniture anything

like that no okay fine and when you're

having you know since this has all

started have you lost sensation around

the private area around the the bottom

area no no so when you're wiping you can

feel the you know yeah all right

brilliant what about things like

incontinence or control over the bladder

and the bowels you've not lost control

or had any moments of where you've felt

like you're not in control of those no

no accidents and I feel like I'm in

control okay brilant so tell me about

your health more generally have you been

having fevers being systematically un

well having vomits with this all that

kind of thing no I felt all right aside

from this all right and have you lost

any weight in the past weeks to months

of your appetite low energy

no no I'm eating drinking uh you know my

weight's been all right being fine so

what about things like inflammation

generally I mean do you wake up with the

pain as and it's worse or does it get

worse as the day goes on no I don't have

any pain in the you know there's there's

no difference between the morning and

the evening okay and more generally your

joint health is okay would you say I

mean your hips your knees generally your

hands yeah absolutely it's fine fine so

in the morning would you feel any

stiffness in your back no not really no

no okay you are still able to get out of

bed yeah Okay so we've talked about a

little about about this back pain I'll

ask more about your General Health and

then we can go on potentially what could

be causing this yeah did you have any

concerns when you first came in any

ideas about what could be going on or um

no I mean I I just want to get better so

that's what your expectations absolutely

I just want to get walking and doing

things again sure absolutely we'll try

and help you best we can with please

okay so bit more about your General

Health have you got any of the medical

conditions that you're under a

specialist for or uh you see a GP for

long standing or short no nothing at all

I'm I'm fitting well so no breathing

conditions asthma cop heart conditions

no diabetes no nothing at all okay and

no liver disease nothing at all

okay tell me about your drug history I

mean you said you've got no medical

conditions and you mentioned the

paracetamol do you have any of

the medications that you taking recently

no I don't take anything you don't take

anything nothing over the counter no

supplements no Herbal Remedies no okay

and are you allergic to anything no okay

more in terms of your Social side what's

your occupation well I'm semi-retired I

was an accountant so I don't go into

work aside from maybe once or twice a

day okay um and I spend most of my time

golfing and traveling and so I live I

live a very very healthy and active

lifestyle okay you know which makes me

even more surprised that I've got back

pain it can happen it's actually very

very common okay back pain you know it

can 10 15% of consults in general

practice do associate with back pain

that that's you know that's reassuring

in some ways yeah so tell me about you

know things like smoking are you a

smoker no I'm not a smoker non-smoker

and what about alcohol intake never

drank it no no okay fine um and tell me

a little bit about your past medical

history in terms of your family um is

there any conditions that run in the

family anything like cancer anything

like

arthritis rheumatism no not that I can

think of no okay and no autoimmune

diseases anything like that no okay

brilliant um what's going on I mean

what's happening to me I mean definitely

I can I've got my main ideas and of

course I would like to examine you but

at the moment my top differential is

something called I right okay have you

heard of this I've heard of it but it

would be good to know about it so

sciatic pain is normally associated with

the stic nerve which runs down uh the

back and into the the legs as well okay

sometimes when this is impinged or

affected by and it could be anything

really could be you know you walk up

funny or you laid funny you could have

had a sour trauma but sometimes we never

get to the bottom of the cause

impingement basically means that the

cytic nerve is basically um affected or

squeezed um could be due to the discs

within the the vertebra of the spinal

column which is the individual bones

which make up the spinal column and that

can sometimes affect the nerve causing

quite classically these symptoms fine

fair enough so you'll experience uh back

pain and unilateral meaning one leg pain

often times weak uh a bit of weakness

pins and needles maybe some numbness

around that area as well that's very

much sounds like me so in terms of

management of stic is quite a difficult

condition to manage in terms of getting

complete control of it but we do have

some effective strategies please I try

anything at this moment what what do I

do as a physiotherapist I can give you

some good exercises that can help you

back Health also to keep you more mobile

and you know certain exercises that can

help with certain twisting bending

motions that you can do with quite

regularly at home and this will help

with your symptoms sounds good and also

building up the back muscles to support

the spine mhm the other thing is pain

relief and analgesia so I can see that

you've been trying

paracetamol but the research shows that

good for this condition is something

called anti-inflammatory non-steroidal

medication so nonsteroid

anti-inflammatories such as

ibuprofen those normally work quite well

are you able to take Ibuprofen I am yes

yeah just as a precaution we'll also

give you um something to protect your

stomach something called lzo okay thank

you very much excellent also things like

self-help such as cold and Heat packs

can often help as well okay we'll keep

an eye on you and in the next couple of

weeks I'll like to see you back in this

Clinic um just to see how you're getting

on with your symptoms see if there's any

change sure in the meantime I want to

warn you about a few symptoms if these

present i' really want you to see

general practitioner or presenter A&E

settings okay these are increasing

worsening of pain or no difference uh

with the interventions in place MH um

anything like you know the numbness

around the the private area or the back

passage right any loss of continence of

the bowels or bladder M you feeling

unwell in yourself moments fevers

associated with the pain any of these

sort of symptoms I would definitely get

immediate medical attention for that

without the general practitioner or

probably a okay no that's that's very

reassuring thank you so much for your

help today so Alan do you have any

further questions for me at this moment

in time no none at all um no okay thank

you very much for your time we'll see

you very soon thank you thank you and I

hope this back pain with these

interventions improves and you can go

back to your golf and your normal

activities I hope so too thank you so

much thank you thank you