Case history
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Multimodale aanpak van chronische primaire pijn (CPP) in de eerstelijnszorgPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2024Prise en charge multimodale de la douleur chronique primaire (DCP) en première ligne de soinsPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2024Case history
A 46-year-old school janitor presents with disabling back pain. While lifting a heavy bucket at work, he developed excruciating back pain, radiating down his leg. The next morning, he had numbness in his big toe and could not get out of bed. He is diagnosed with an acute L5 radiculopathy and undergoes uncomplicated surgery. One-month postoperative examination shows lower extremity good strength, reflexes and sensation. Forward flexion of the back is moderately decreased, and the muscles next to the spine are increased in bulk and tender to gentle palpation. Repeat MRI and EMG testing are unremarkable. The patient is released to return to work. Three months postoperatively, the patient consults his family doctor for persistent pain and inability to return to work. He is prescribed exercises and asked to return to work part time. Six months postoperatively, the patient is irritable and depressed and has not returned to work.
Other presentations
Persistent pain may occur after an injury or illness, in conjunction with degenerative illnesses (e.g., arthritis) or spontaneously (e.g., migraine or fibromyalgia).
Pregnancy is associated with increased risk for a variety of musculoskeletal and neuropathic pain conditions. The most common pregnancy-related pain is low back pain.[3] Compressive neuropathies also occur more commonly during pregnancy, including carpal tunnel syndrome and meralgia paresthetica.
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