Case of the Month #26: Myeloma Pain by Dr Sonia Pierce
Mr T is a 59-year-old male who was referred by his GP to the chronic pain service with persistent spinal pain, extending up from his lumbar to his mid scapular region.
He has experienced intermittent episodes of lumbar back pain in the past, but this episode felt different. It began gradually, approximately six months ago, with no obvious precipitating injury. He dismissed it at first and initially thought it would settle down, like his previous episodes had done so. His pain made going to work more of a struggle. He asked to be referred to a pain clinic in the hospital he worked because this has been mentioned to him in the past during one of his episodes of low back pain. His pain did not improve with simple analgesia and exercise, so his GP referred him to his local chronic pain service.
- If you were the pain clinician seeing him for his first consultation, what questions would you like to ask?
- What might you look for on examination of the patient?
- Would you ask for any further investigations?