Case of the Month #27: Lower back and buttock pain by Dr Kerry Bosworth
Mrs C was tearful during the consultation, especially during discussions that no new “magic” treatments had become available since her consultations with her previous pain service. No red flags were identified.
She was asked to complete psychological screening questionnaires. She scored highly on the PHQ-9, GAD-7 and Pain Catastrophizing Scale (PCS) but felt any anxiety and depression was all due to her pain. She acknowledged that her pain experience had a significant impact on her thoughts and feelings.
She expressed frustration that she couldn’t tolerate an MRI scan as she felt it might give her an answer about the cause of her pain but was adamant this would not be possible. She was unkeen on further injections for her pain due to her nerve block experience.
On examination, she was globally tender over her lower back and buttocks with an area of increased tenderness in her right buttock. She found any movement of her hip joint too painful to continue with the examination.
- What are your differential diagnoses?
- How would you manage this patient?