Diana (59 years old)

Diana is a 59-years-old physics professor who has been struggling with low back pain for 10 years.

In her medical record, the following is noted:

• Former smoker (15 pack years)
• No alcohol consumption
• BMI: 32
• Hypertension (treated with olmesartan 20 mg 1/day)
• Lumbar facet joint OA with intervertebral disc degeneration (treated with paracetamol 1 g, as needed)

She presents to your clinic with worsening and continuous low back pain (VAS: 7/10). Paracetamol insufficiently alleviates the pain, leaving her unable to resume daily activities.

She feels increasingly frustrated about the pain, so she asks for help.