45-year-old male with low back pain requesting prescription for strong painkillers

This office worker, who has been off work for 3 months because of low back pain after an injury at work, also asks if he needs an x-ray. As his GP, what can you tell him?

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A 45-year-old male office worker has been off work for 3 months because of low back pain. He sustained a back injury when lifting a cabinet at work.

The pain is confined to his lower back and does not radiate to his legs. He has a normal examination and no neurology or constitutional symptoms are present. He has normal sensation and is able to open his bowels and pass urine normally. The pain is worse on standing for longer periods of time and sleeping tends to help relieve the pain.

He asks whether he should have an x-ray to work out why he is getting pains. Finally, he asks you for a prescription for tramadol as he had this previously and feels it would help him control his pain. He also has a friend who was given a TENs machine for pains and wonders if he might be able to try this to help.

You note that he seems quite down in his mood and discuss with him about how being out of work for such a time has been a real struggle for him. Due to the coronavirus pandemic he finds he is not getting out for exercise and tends to just sit on the computer for long periods of the day.

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