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 Case
#30 "I Need Something for This Pain!"
A 33 y/o male presents with a chief
complaint of back pain. The pain started
seven days ago, and has been getting
progressively worse. He notes it started
when he was helping his friend move out of
his apartment. He had to help him move
quickly as he was getting evicted, and the
patient notes he worked really hard. The
pain is located in the lumbar area, no
radiation, no numbness or weakness. It gets
worse when he moves, feels better at rest.
ROS: He denies fevers, has felt chills, no
rashes, no nausea, vomiting, no urinary
complaints, no penile discharge, no
constipation or other bowel problems.
PMH: Ulcers and pancreatitis.
Surgical history: Negative
Social history: Drinks every weekend, and
sometimes on the weekdays. Reluctantly, he
admits to drug abuse. He snorts heroin, but
he used to shoot (hasn’t shot up in years).
PE: Well appearing thin male, grimacing on
cot. Poor historian and asking for pain
medications before answering most questions.
VS: 145/90, HR=101, RR-20, T=98.9F Sat-96
(room air)
HEENT: WNL
Heart: RRR no murmur, rubs or gallop
Lungs: Clear bilaterally
Abd: Soft , scaphoid, non-tender, normal bowl sounds
Ext: Multiple defects from skin popping. No
cellulitis or infected lesions.
Back: Tenderness at L/S mid area. Neg.
straight leg raising sign.
Rectal: Guiac neg, normal exam.
Neuro: Alert and oriented x3, motor 5/5
(with grimace when testing leg strength or
gait). Sensory WNL. Cranial nerves normal,
reflex: normal. Cerebellar exam, normal.
Gait, leans back with arched back and walks
slowly.
1. Should you get an X-Ray?
2. Should you give him anything for pain?
3. Any blood tests helpful?
4. If your workup in the ED is normal, what
is the disposition and follow-up?
Click here for answers and to respond
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