Ms. J. is a 30-year-old healthy single mother with two children.

Case Study B:

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Ms. J. is a 30-year-old healthy single mother with two children. She has worked as a paramedic in her community for 6 years. She and her partner responded to a call involving a man who had been drinking heavily at a family party and who was partially conscious. When she and her partner attempted to transfer the 100-kg man to a stretcher, the man grabbed her neck, causing her severe pain. Ms. J.’s doctor diagnosed a spinal injury and completed papers for Ms. J. to be absent from work. He recommended rest and application of heat and cold to the neck. One week later, Ms. J. saw him again, reporting continuing pain. She was referred to a specialist who told her she had a herniated disk in the cervical area of her neck and would require ongoing care and rehabilitation. Ms. J. has been on disability leave for 6 months, during which she has continued to have severe neck, jaw, and back pain. She takes acetaminophen with codeine as required, and sees a physiotherapist and a registered massage therapist routinely in an attempt to control chronic pain. She is worried that her disability benefits will cease before she can return to work and has incurred debts during her leave. She also finds it difficult to care for her two children and keep the house clean.

1.What factors are significant in Ms. J.’s perception of pain? How might each be reduced?
2.Why has Ms. J.’s doctor not prescribed stronger narcotic medication?
3.Why does Ms. J. experience pain in her jaw and lower back when the injury was to her neck?
4.Where in the pain pathway do massage therapy and physiotherapy act to alleviate pain?
5.Ms. J. is concerned about maintaining her physical fitness and decides to attend exercise classes in her community pool. She finds this gives her more energy and reduces her pain. How does appropriate exercise affect pain perception? What precautions does Ms. J. need to observe when exercising?
6.Ms. J. hears about acupuncture as a help for back pain and does some research on the Internet before making an appointment for treatment. How could acupuncture act to block impulses for pain?
7.After 8 months, Ms. J. is cleared to return to work on a part-time basis, which she manages well. Why does she not return to full-time work immediately?
8.What can Ms. J. expect in the future as a result of this injury?