Case Study: Patient with Back Pain, Anxiety, and Marijuana Use

This case study presents a 35-year-old patient experiencing chronic back pain following participation in a volleyball league, alongside a history of anxiety and marijuana use. The analysis delves into a differential diagnosis, considering factors such as repetitive strain, mental health, and static posture, and the need for x-rays and MRIs. The first course of action includes flexion-extension exercises and spinal bracing. The safety issue is the patient's chronic marijuana use, exacerbated by his isolated living situation, potentially leading to adverse mental health outcomes. The case highlights the need for referral to mental health services, particularly SAMHSA, and concludes with spinal assessment involving X-ray to determine the presence of any structural deformities, trauma, or congenital defects.

Running head: CASE STUDY
CASE STUDY
Name of the student:
Name of the university:
Author note

1
CASE STUDY
Introduction:
The case study involves a patient of 35 years who has a history of back pain, anxiety, and
marijuana use. The patient currently experienced chronic pain after joining the volleyball
Thursday night league volleyball team. This paper will provide details of the diagnosis and
safety issue of the patient in the following paragraphs.
Differential diagnosis:
Mizoguchi et al. (2019), suggested that among volleyball players, playing is one of the
common reasons for chronic pain and volleyball may also increase the risk for a stress fracture in
the low back called spondylolysis. Mental health is also another reason for the development of
lower back pain. Since the patient had a history of chronic back pain, repetitive strain injury or
traumatic injury is also common (Dunn, 2019). Since the patient is working in a fast-food center,
static posture can increase the risk of developing back pain amongst patients. It might be the case
due to the constant standing posture, the patient experience Kyphosis or scoliosis (Kim & Iyer,
2016). In this case, an x-ray is required to conduct for measuring the curve of the spine. The MRI
can be conducted for spondylolysis since MRI of the spine will show the bones, spinal cord,
disks and spaces between the vertebral bones where nerves pass through (Furlan et al., 2015).
The questionnaire is required to develop for the patient to assess the anxiety symptoms and
intensity for gaining an understanding of whether the back pain is induced due to the anxiety.
The first course of action:
In this context, the first course of action will be flexion-extension exercise and lateral
flexion exercises would be given to him. Spinal bracing would be done for the patient for
stabilizing the muscles of the vertebral column (Jaccard et al., 2019). Breathing monitoring along
with vital signs would be done along with pain assessment would be done for the patient.

2
CASE STUDY
Safety issues:
In this context, the safety issue is chronic marijuana use. The patient lives alone and
works at a fast-food restaurant. According to Erikson's psychosocial development, he is
experiencing the stage, “intimacy vs isolation”. During this period, the individuals begin to share
a more intimate bond with a partner (Weisskirch, 2018). On the other, a lack of a partner or
conflict with a partner will subject patients in isolation. In this context, since he lives alone, he is
experiencing that isolation which resulted in adopting the unhealthy habit of consuming
marijuana which gives euphoric experience (Schachter, 2018). However, the overdose of
marijuana may induce toxic effects or induce an unpleasant episode of acute fear, depression or
risk of suicide. The physical impact can be to increase pressure, nausea. Hence, it can be
considered as the safety issue of the patient. At this juncture, the patient can be referred to mental
health services, SAMHSA program under the SUPPORT Act 2018 (Gould, VanMeter & Hubert,
2014).
Summarize:
As discussed in the case study, the patient is experiencing lower back pain after
involving in the game. In this context, the final diagnosis would be spinal assessment with Xray.
Xray will provide the idea of deformity of the structure, trauma injury or any other congenital
defects.

3
CASE STUDY
References
Dunn, B. (2019). Lumbar spondylolysis and spondylolisthesis. Journal of the American
Academy of PAs, 32(12), 50-51.
Furlan, A. D., Giraldo, M., Baskwill, A., Irvin, E., & Imamura, M. (2015). Massage for low‐back
pain. Cochrane database of systematic reviews, (9).
Gould, B. E., VanMeter, K. C., & Hubert, R. J. (2014). Gould's pathophysiology for
the health professions.St. Louis, MO: Elsevier Saunders.
Jaccard, H., Meyer, F., & Preatoni, E. (2019, May). Influence of speed and amplitude of rotation
of a motorised rotating platform on knee kinematics. In World Confederation for
Physical Therapy Congress 2019.
Kim, H. J., & Iyer, S. (2016). Proximal junctional kyphosis. JAAOS-Journal of the American
Academy of Orthopaedic Surgeons, 24(5), 318-326.
Mizoguchi, Y., Akasaka, K., Otsudo, T., & Hall, T. (2019). Factors associated with low back
pain in elite high school volleyball players. Journal of physical therapy science, 31(8),
675-681.
Schachter, E. P. (2018). Intergenerational, unconscious, and embodied: Three underdeveloped
aspects of Erikson’s theory of identity. Identity, 18(4), 315-324.
Weisskirch, R. S. (2018). Psychosocial intimacy, relationships with parents, and well-being
among emerging adults. Journal of Child and Family Studies, 27(11), 3497-3505.