Nontraumatic musculoskeletal pain: Test your skills with these 5 questions
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Herbert L. Muncie Jr., MD, is a Professor of Family Medicine in the Department of Family Medicine, LSU Health, New Orleans, LA. Dr. Muncie is also a faculty member of the National Family Medicine Board Review course.

Question 1 of 5

A 39-year-old man, who works as a landscape installer, visits your office for the first time. He says he has had chronic back pain for the past 3 years. He describes the pain as dull, nonradiating, and located in the lower midline back. He says the pain is worse with prolonged physical activity. He uses ibuprofen occasionally, but says it does not help much.

The physical and neurologic examinations are normal. He has no sensory or motor deficits. The straight leg raising test is negative. His vital signs are normal and his body mass index (BMI) is 30.6.

Which statement is correct regarding initial treatment and evaluation of this patient’s chronic low back pain?

Order plain x-rays of his lumbosacral spine, recommend weight loss, and give no medication.

Recommend no x-rays but recommend yoga, because yoga would be somewhat helpful in reducing his pain and improving his function.

Order plain x-rays of his lumbosacral spine and recommend acetaminophen 1000 mg 3 times a day for 10 days.

Recommend no x-rays, but order a low-dose narcotic used regularly to improve his pain and function.

This quiz is not accredited for CME.

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