A 76-year-old man comes to the office with a 2-month history of progressive low back pain. The pain is relatively constant and nagging and is unrelieved by rest or position changes. It is especially bad at night and interferes with sleep. The patient has taken acetaminophen and ibuprofen without relief. Medical history is significant for hypertension and osteoarthritis affecting the knees and hands. The patient used intravenous drugs occasionally when he was younger but not for 30 years. Which of the following processes is most likely responsible for this patient's back pain?

Question

A 76-year-old man comes to the office with a 2-month history of progressive low back pain.  The pain is relatively constant and nagging and is unrelieved by rest or position changes.  It is especially bad at night and interferes with sleep.  The patient has taken acetaminophen and ibuprofen without relief.  Medical history is significant for hypertension and osteoarthritis affecting the knees and hands.  The patient used intravenous drugs occasionally when he was younger but not for >30 years.  Which of the following processes is most likely responsible for this patient's back pain?

Quizplus · Accepted Answer

Eductional Objective: Clinical features that suggest a malignant cause of back pain include persistent pain at night, no relief with rest, onset at age >50, and systemic symptoms.  Common malignancies with a propensity for bony metastasis include prostate, breast, kidney, thyroid, and lung.

A 76-Year-Old Man Comes to the Office with a 2-Month