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 Lawrie, 82 year old married man  Ex-engineer, enjoys fishing from his boat and visiting their beach house on Bribie Island  Back pain slowly progressive.

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Presentation on theme: " Lawrie, 82 year old married man  Ex-engineer, enjoys fishing from his boat and visiting their beach house on Bribie Island  Back pain slowly progressive."— Presentation transcript:

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4  Lawrie, 82 year old married man  Ex-engineer, enjoys fishing from his boat and visiting their beach house on Bribie Island  Back pain slowly progressive over last few years  Old ‘lumbago’ since 50s after slipping on boat  Can’t go shopping with wife any more – she thinks he’s avoiding because he stops early complaining of back and leg pain after being ok to start with  Mornings are ‘a bit stiff’ in all the wrong places so slow to start but gets going well as long as not walking too far  Notes that has trouble sit-to-stand and walking down stairs  Pain radiates down legs R>L when worse, more often  Otherwise well – some ‘prostatism’, HTN, central obesity

5 Considerations - Probable cause – traumatic, degenerative, radiculopathic, stenotic, disc related, inflammatory, infective, malignant - Disability / functional impairment / effects - Investigations – past, timing, planned - Level of intervention patient is prepared to consider / undergo / tolerate - Previous treatment approaches and successes - Comorbidites

6  History – injury, pattern, disability, associated  Examination – neurological, muscular, skeletal, joint, evidence of degenerative disease, malignancy, autoimmune disease etc  Functional assessment – Gait, STS, TUG, flexibility  Investigations should include paraproteins, inflammatory and infective causes, nerve conduction studies and imaging as indicated

7  Degenerative osteopathies and discopathies  Spondyloarthopathies  Inflammatory causes including AID  Infective causes including discitis and abscess  Compressive causes including haematoma  Vascular including ischaemia and AVM  Myeloma and metastatic disease

8  Likely degenerative changes in spine – multifactorial  Pain pattern suggests spinal stenosis  Radiculopathy and weakness suggest urgency  No talk of previous intervention, investigation, treatment attempts  Possible disc injury in past when slipped  Possible secondary gain per wife’s perception  Functional bottom line likely high – fishing on boat  Essential – examine, imaging, planning  Options include everything from analgesia and reconditioning through all the interventions so patient’s perceptions, time frames, expectations must be clear

9  Non-pharmacological including  Complementary and Alternative / Relaxation / Faith  Psychological adjuncts  Lifestyle planning  Education  Pharmacological – analgesics, co-analgesics, psychological  Interventional including surgical, anaesthetic, ablative and implants  Medium and long term planning  Setting limits, preconditioning, planned reconditioning, function maintenance therapies

10  Co-morbidity status and medical optimisation  Environmental management  Pain management  Equipment – assess, provide, monitor, manage, follow-up  Day rehab, inpatient rehab, planned off-season workup

11  Assessment – pain, co-morbidities, psychological  Restorative care  Management planning consultation  Multidisciplinary input and management  Intervention  Follow up

12  Pre-operative assessment  Planned timing  Pathway to  Post-op care  Restorative care plan

13  Multidisciplinary assessment  Goal setting and education  Periodic review and outcome assessment  Supports / Caregiver involvement  Discharge planning  Environmental modifications  Aids – temporary, long term  Supports - functional, access (permits etc), respite  Ongoing review  Driving, progress, day therapy

14  Bio-psycho-socio-interventional-surgical- restorative approach  Create a co-ordinated systematic approach  Multidisciplinary approach from the start  REFER

15 Dr Fiona Harris, MBBS, FRACP  Consultant Physician and Geriatrician  Dr Anthony French, MBBS, B.App.Sc., FRACP  Consultant Physician and Geriatrician  Queensland Geriatric Medicine Group  


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