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Case 5 - Xanthe: The Worse It Gets. and Now That It's Interrupting My Sleep It's Really Getting Me Down" - Xanthe

Xanthe is a 27-year old university student experiencing increasing low back pain that is interfering with her daily activities like sitting in lectures and driving. Over the past 3 months, she has had pain in her lower back, buttocks, and thigh that worsens with prolonged sitting. She also has sharp catching pain when getting up from sitting or lying down. A recent long flight exacerbated her pain and she has since had difficulty sleeping due to pain. Xanthe is concerned about how her back pain will impact upcoming exams and teaching placement. She seeks treatment but lacks private health insurance to cover ongoing care.

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Jess Marriott
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94 views1 page

Case 5 - Xanthe: The Worse It Gets. and Now That It's Interrupting My Sleep It's Really Getting Me Down" - Xanthe

Xanthe is a 27-year old university student experiencing increasing low back pain that is interfering with her daily activities like sitting in lectures and driving. Over the past 3 months, she has had pain in her lower back, buttocks, and thigh that worsens with prolonged sitting. She also has sharp catching pain when getting up from sitting or lying down. A recent long flight exacerbated her pain and she has since had difficulty sleeping due to pain. Xanthe is concerned about how her back pain will impact upcoming exams and teaching placement. She seeks treatment but lacks private health insurance to cover ongoing care.

Uploaded by

Jess Marriott
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CASE 5 – XANTHE

Xanthe is a 27-year old university student studying teaching. She attends 20-30 hours of lectures and
practical classes each week and works part-time at a medical clinic as a receptionist. She occasionally
attends exercise classes at the gym and used to play social netball once a week.

Over the last 3 months Xanthe has been experiencing a gradual progression of pain in her left lower
back, upper buttock and into the left posterior thigh. When sitting in lectures for more than 60
minutes the pain in the back and leg reaches 5/10 and she needs to change position to get relief.
These same symptoms occur with driving more than 45 minutes. She also experiences more severe
sharp ‘catching’ pain in her back when she gets up from sitting or lying, or bends over to put her
socks and shoes on. She reports that this catching pain is happening more and more often.

Last week Xanthe flew to Melbourne for a wedding and during the flight home the pain became
more severe and she had difficulty getting up from the seat and carrying her luggage. She saw her
GP the following day who prescribed Endone and muscle relaxants to manage her symptoms. Since
the flight, she reports that her back feels ‘twisted’ and she has been unable to return to classes as
sitting is too painful to manage. The pain has now settled back to a manageable level however she
reports that her back still feels twisted and she is worried it will get worse again. The pain is
interfering with her sleep as the catching pain wakes her up when she tries to change position.

Xanthe has end of semester exams approaching in 2 weeks, as well as starting a placement in a new
school in 1 month. She is anxious about how her back pain and difficulty sleeping will impact on her
ability to be prepared for these. She is also concerned that she may need an MRI, but is frustrated
that her GP will not refer her on for this. She has come to see you in a private practice but does not
have private health cover and is concerned that she will not be able to afford ongoing treatment.

“I couldn’t cope with it when it flared up and it just happened so easily. The more I think about it too
the worse it gets. And now that it’s interrupting my sleep it’s really getting me down” – Xanthe.

Student 1: Interview, assessment & outcome measures


Discuss your interview and assessment of this patient. Identify the medical and situational issues
that make this case complex. Identify appropriate outcome measures. In addition, outline your joint
goal setting with this patient - long and short-term goals. Ensure you provide specific, measurable,
action-orientated, realistic, and timed goals. Support with evidence from the literature.

Student 2: Underlying mechanisms, prognosis & management


Discuss the possible mechanisms underlying the patient’s pain and loss of function that direct your
management approach and prognosis. Outline the prognosis for this patient and prioritised initial
management plan to address the problems identified by the patient, including self-management.
Support with evidence from the literature.

Student 3: Interprofessional & extended management planning


Identify the systems issues that make this case complex and discuss what you need to consider and
what your role could be. Discuss whether there is a role for other professionals in the management
of this patient. If so, outline the role of this professional/s and your communication with them. In
addition, discuss the management plan that extends beyond the initial management. Support with
evidence from the literature.

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