A 60-Year-Old Woman Comes to the Office Due to Back

question 709

Multiple Choice

A 60-year-old woman comes to the office due to back pain.  For the last 3 months, the patient has had dull, achy pain in the lumbar area radiating to the buttocks bilaterally.  The pain is worse with lifting heavy boxes and is not relieved with acetaminophen or heating pads.  She has had no fever, weight change, dysuria, incontinence, abdominal pain, or muscular weakness.  The patient's medical history is notable for hypertension, for which she takes chlorthalidone, and osteoarthritis of the knees and hands.  She does not use tobacco, alcohol, or illicit drugs.
Blood pressure is 148/98 mm Hg and pulse is 84/min.  BMI is 32 kg/m².  Examination shows normal range of motion in the lumbar spine.  Lower extremity strength, sensation, and reflexes are normal.  Straight leg raise causes worsening of pain in the back but no radiation of pain.
Laboratory results are as follows:
MRI of the lumbar spine shows a mild L4-L5 disc bulge without neural impingement and moderate facet arthropathy at multiple levels.
Which of the following interventions is most likely to be beneficial for this patient?

• A)Activity limitation and naproxen prescription
• B)Carisoprodol prescription
• C)Multidisciplinary rehabilitation program
• D)Transcutaneous electrical nerve stimulation
• E)Trial of glucocorticoid injection

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Definitions:

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Enduring characteristics or qualities that define an individual's personality.

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