NURS 6512 ASSESSING MUSCULOSKELETAL PAIN

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NURS 6512 ASSESSING MUSCULOSKELETAL PAIN

Your episodic  note was well crafted and thorough. Your differential diagnosis are appropriate and well explained. It is essential to consider a comprehensive set of differential diagnoses when evaluating a patient with lower back pain to ensure that all potential causes are thoroughly explored. In addition to muscle spasm and avascular necrosis, the following differential diagnoses should also be considered with rationale:

  1. Lumbar Radiculopathy: Given the patient’s description of radiating pain to the left leg, which feels like an ice pick, and worsens during specific activities, lumbar radiculopathy, commonly known as sciatica, should be considered. This condition results from compression or irritation of the spinal nerve roots and can cause radiating pain, tingling, or numbness in the lower back and leg (Koes et al., 2007).
  2. Spinal Stenosis: The patient’s worsening pain during prolonged sitting, such as during his commute, is consistent with the symptoms of spinal stenosis, a condition characterized by the narrowing of the spinal canal, leading to compression of the spinal cord or nerves (Genevay et al., 2010).
  3. Sacroiliac Joint Dysfunction: Sacroiliac joint dysfunction can produce symptoms of lower back pain that may radiate to the buttocks and legs, which aligns with the patient’s presentation. This condition is often aggravated by prolonged sitting or standing (Cohen & Vasey, 2016).
  4. Facet Joint Syndrome: Facet joint syndrome can cause localized lower back pain that may radiate to the hips and legs, and the pain can be exacerbated by specific movements or positions, such as bending backward, which matches the patient’s description (Cohen & Vasey, 2016).

These additional differential diagnoses expand the scope of potential causes for the patient’s lower back pain and provide a more comprehensive assessment of his condition.

References:

Cohen, S. P., & Vasey, M. W. (2016). The effect of the avoidance-endurance model on acute pain perception: An experimental investigation. The Journal of Pain, 17(11), 1224–1233. https://doi.org/10.1016/j.jpain.2016.08.004

Genevay, S., Atlas, S. J., & Katz, J. N. (2010). Variation in eligibility criteria from studies of radiculopathy due to a herniated disc and of neurogenic claudication due to lumbar spinal stenosis: A structured literature review. Spine, 35(7), 803–811. https://doi.org/10.1097/BRS.0b013e3181b3f2e1

Koes, B. W., van Tulder, M. W., Peul, W. C., & Jansen, M. J. (2007). Diagnosis and treatment of sciatica. BMJ, 334(7607), 1313–1317. https://doi.org/10.1136/bmj.39223.428495.BE

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