Ms Q is a 46-year-old female with a past medical history significant for depression, gastroesophageal reflux, and a motor vehicle accident 7 years ago. Over the last 3 years she has developed worsening low back pain that she feels is limiting her ability to carry out her activities of daily living. She works as a heavy equipment operator at a local factory. She denies fevers, chills, weight loss, and bladder or bowel habit changes. She denies radicular pain and numbness or weakness in her legs. Her vital signs include a blood pressure of 128/65, heart rate of 72 bpm, respiratory rate of 16/min, and temperature of 37.2°C. She is seeing you for the first time for pain control and is requesting opioid medication.
1. What is your differential diagnosis?
2. What are the key elements of the history and physical examination?
3. What diagnostic evaluation should be done for this patient?
4. What are the best treatment strategies for her pain?
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