29th January 2024

A 67-year-old retired driving instructor visits her GP practice with a 4-month history of lower back pain

A 67-year-old retired driving instructor visits her GP practice with a 4-month history of lower back pain, generalised body aches and fatigue. She says that despite feeling exhausted, she is unable to sleep through the night and frequently awakes in the early morning. She has been able to continue cooking for her husband but says that she is no longer interested in food and generally skips meals. She has lost 4kg in weight but is unsure of the timeframe of this.

She describes the back pain as constricting and non-radiating. It is worse on standing and improves through the day. She says that she feels very sad, tearful and that she is preoccupied by her pain, to the point that her husband has become quite frustrated with her. She feels very guilty about making her husband’s life ‘miserable.’ She is extremely worried that the same will happen to her sister, who is one year younger than her. She has tried paracetamol and ibuprofen to no effect. There are no neurological or inflammatory symptoms on examination.

Which of the following diagnoses is the most likely?

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