Collaborative care for a patient with complex low back pain and long-term tobacco use: a case report

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Table 1.

Clinical history and concurrent conditions

Diagnosis	Health History and Current Status
Spinal conditions	Lumbar disc degeneration (Figure 1) Lumbar central canal stenosis L4-S1 bilateral neural foraminal stenosis 21° left lumbar curvature (Figure 2)
Activities of daily living impairments	Reduced ability to stand and walk with limitations reported in ability to shop, cook, clean and garden Timed get up go test averaged 11.63 seconds (independent mobility); patient had shooting pain into left thigh with test Exercise avoidance due to pain reported with movement Positional sleep interruption resulting in fatigue Increased bed rest for pain relief
Tobacco dependence	Current cigarette smoker reporting 1.5–2 packs/day 60–90 pack-year history over 45 years Self-reported use of tobacco as coping mechanism for back pain
Obesity	History of bariatric surgery (Figure 2) Body Mass index = 33.1 (Height 164.08 centimeters, Weight 88.90 kilograms)
Mental health conditions	Self-reported history of anxiety, depression and post-traumatic stress disorder Self-reported current life and family stressors Previously treated with supportive therapy and medication Currently not receiving any mental health care
Benign positional vertigo	Self-reported fall 3 years ago due to vertigo symptoms Symptoms recurrent but milder than at onset
Cardiovascular conditions	Hypertension medically managed with angiotensin converting enzyme inhibitor/diuretic Blood pressure 132/75 Abdominal aortic calcification (Figure 1)