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Back pain

Scenario: Bob, 50 years old, comes to you complaining of a very sore back. In the course of conversation he tells you he was a 'brickie' and that he 'did the disc...when Melbourne got the grand final' (in other words years ago), and that 'the compo's all gone now'. He says: 'It's the beds...me back's gettin' worse cos I'm always in a different bed...I can't afford a place of me own...can't 'ave me own bed...It's agony tonight...can 'ardly move...the pain.' You suspect that perhaps the park benches he uses are equally to blame.

This pain could be due to:

• A 'pinched nerve', which means that a disc is pushing on a nerve in the back. These often recur, but tend to heal themselves.
• A problem with a vertebrae (bone) in the back.
• Vertebrae damaged either by falls (alcoholics often don't recall them) or by other significant diseases.

Advice:

In this situation there is a need to reassure Bob. Ask if he has any medication for his back (search for this if he seems vague). Back pain is rarely an urgent problem. However, back pain can be severe and the usual treatment is a combination of bed rest and 'pain killers'. See page 124 for a full list of pain killing tablets. If he is not allergic to aspirin or Panadol® then either one may be given until Bob is examined by a doctor. Physiotherapy may also help after a suitable rest period.

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