Case 6 | History

41 year old Melanie, a legal secretary, presents to your afternoon clinic which lower back pain.

You have met her on one previous occasion with the same complaint 3 months ago.  The pain did not fully resolve but did subside to allow her to get back to work, but only in the last 2 weeks.

This time she explains that she has experienced a sudden increase in the pain again last week while at work.  Since this time she has been in bed taking her regular analgesia but now has run out.

She explains the pain came on while she was lifting a block of papers off a low chair.  The pain was localized to the centre of the lower back and moved into both buttocks.  It has been constant since and not responded to her pain relief.  She has been unable to work and her partner has also taken some time off to look after her.

She denies any neurological symptoms in the lower legs and has normal urinary control and sensation.  She explains that her bowels have been troublesome in the last week and noticed one episode yesterday morning of soiling.


Past Medical History


Irritable bowel syndrome.

Lower back pain – first episode 3 months ago.  After a period of rest, time off work and pain relief this improved.



Citalopram 40mg OD.

Co-codamol 30/500 QDS.

Tramadol 100mg QDS.

Quinine sulphate 200mg Nocte.


Allergies :  NSAID’s – gives terrible indigestion.


Systemic Review

General            - General malaise.

Cardio              - Nil.

Respiratory      - Nil.

GI                     - Occasional constipation.

Neurological     - Nil.

GU                    - Nil.



Works in busy law firm for last 5 years.  Poor job satisfaction with multiple episodes of absence from work due to sickness.

Lives with partner, two children.

Smoker 20/day.

Social alcohol.


Family History

None of note.