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A patient has come into the community pharmacy complaining of pain. The student must conduct a thorough patient history to uncover the cause of the pain. The student should navigate the conversation and provide appropriate guidance and recommendations while ensuring patient safety.
Please ensure that this scenario and mark scheme aligns with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.
You will need a student pharmacist and an actor for this OSCE station.
Back Pain
NSAIDs
You are a pharmacist working in a community pharmacy. A middle-aged male comes in complaining of pain. You need to take a detailed history from the patient to understand the cause of the pain and provide guidance on further action.
To do:
Conduct a thorough medical history assessment.
Based on the information gathered, formulate a treatment plan or, if necessary, recommend a referral to a healthcare provider or emergency services for further evaluation and management.
You have 8 minutes.
You have access to the BNF.
You are Peter Novik (Pee-tah, No-Vik).
Opening Statement: "I've noticed pain in my lower back, and it's worrying me. Is there anything you can do to help"
Patient Information:
Name: Peter Novik
Age: 38
Medical History:
“None.”
Current Medication:
“I only take a multivitamin daily. I am taking painkillers for this back now too”
Allergies:
“I don’t think so.”
Symptoms:
“It is a crampy pain and muscle soreness in the lower back, I noticed it after I started lifting heavy boxes at work in the warehouse last week.”
If the pharmacist asks:
“It has happened in the past, but the pain is more constant now and affecting my ability to work.”
“No other symptoms, feel otherwise fine.”
“I want to avoid taking any more tablets – if you could recommend me an alternative that would be good.”
The student should offer you ibuprofen gel or a suitable alternative. You should prompt the student:
“Does this medicine come with any side effects?”
“How do I use I?t”
Any criteria marked in red must be met to pass this station.
Red Flags missed: 0
Failed missed: 2
Referral Information for Lower Back Pain
Refer to A&E if:
Sudden onset of severe back pain with loss of bladder or bowel control:This may indicate a serious condition such as cauda equina syndrome, which requires emergency medical attention.
Back pain accompanied by numbness or weakness in the legs:Especially if it affects both legs or is worsening rapidly, this could suggest nerve compression or spinal cord involvement.
Severe back pain following a significant trauma or injury:This requires immediate evaluation to rule out fractures or other serious injuries.
Back pain with unexplained weight loss or fever:These symptoms could indicate a serious underlying condition, such as an infection or malignancy. This would need prompt assessment.
Refer for an urgent GP appointment if:
Back pain that persists or worsens over weeks:If the pain does not improve with initial treatment or rest, further assessment is needed.
New back pain in patients over 50 or under 20 years of age:This may require additional evaluation to determine the underlying cause.
Back pain that radiates down the leg (sciatica) and does not improve with conservative treatment:This may require further investigation and specialist referral.
Presence of other concerning symptoms such as night pain or pain that is not relieved by rest:These could indicate more serious underlying conditions such as infections, tumours, or fractures.
Refer for a routine GP appointment if:
Mild to moderate back pain lasting longer than 4-6 weeks:If the pain persists despite initial self-care measures, a GP assessment is needed for further management.
Patients seeking advice on pain management or physical therapy options:A GP can guide appropriate treatments and referrals if needed.
NHS, 2024. Back Pain. Available at:https://www.nhs.uk/conditions/back-pain/
Clinical Knowledge Summaries (CKS), 2024. Low Back Pain and Sciatica. Available at:https://cks.nice.org.uk/topics/back-pain-low-without-radiculopathy/diagnosis/assessment/#red-flags
NICE Clinical Knowledge Summaries (CKS), 2023.Back Pain – Low (Without Radiculopathy). Available at:https://cks.nice.org.uk/topics/back-pain-low-without-radiculopathy/[Accessed 24 August 2024].
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