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Table 1.

Return to:   Collaborative Care for a Patient with Complex Low Back Pain and Long-term Tobacco Use

Clinical history and concurrent conditions

DiagnosisHealth 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
  • 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)