Thank you for asking me to see this young lady with low back pain. Harrington rod surgery on the 2nd March 1989, left her with a constant low grade ache in the low back.
However, for the past twelve months she has had a more severe pain in the area of the scar which she describes as a tense and sore pain which becomes atbbing with prolonged walking, standing and sitting. When severe, coughing will aggravate the pain. There is no radiation of pain into the leg or elsewhere.
Pain kilelrs in the form of occasional Diclofenac reduce her symptoms a little bit. In bed she lies on her side and lying flat on her back aggravates her pain. She has had no other treatment for this pain. I note that she was seen by Dr Jackson a year ago who thought that this was a facet joint syndrome. She has recently finished a job which involved heavy lifting! She takes oral contraceptive pill and has no allergies.
On examination she was exceedingly timid and tearful. She was thin, and in the back there was a well healed Harrington rod scar and a well healed scar over the left posterior superior iliac spine. Flexion was slightly reduced but pain free but any attempt at extension was painful. Resisted rotation was not painful. She was maximally tender over the left L5/S1 facet joint with marked tenderness also over the joint above. Although she described most of her pain over her scar, in fact she was much less tender in this area. There was no allodynia in this area.
I think this is alregly a mechanical pain originating from her facet joints. As Simone is so frightened of needles, even though I could do this with sedation she was not keen. I have therefore suggested she has some physiotherapy and I have organised this today. I have also suggested she take analgesia regularly until physiotherapy starts. I have suggested Voltarol 50mg t.d.s and either Paracetamol or Solpadeine 6 tablets per day. I have advised her that she should start some activities to strengthen her back such as a swimming, and the use of a jacuzzi may be helpful. I have advised her that she must not lift and twist.
I will review her after this treatment and decide whether I feel at a later date she may need facet joint injections.
Dr Stubbing reporting to Dr Watters after a consultation.