RT Book, Section A1 Murtagh AO, John A1 Bird, Sara SR Print(0) ID 1163949662 T1 Musculoskeletal twists and turns T2 Murtagh's Cautionary Tales, 3rd Edition YR 2019 FD 2019 PB McGraw-Hill Education (Australia) Pty Ltd PP Sydney, Australia SN 9781743767443 LK murtagh.mhmedical.com/content.aspx?aid=1163949662 RD 2024/10/09 AB Susan, a 39-year-old fashion designer, presented because of very severe pain in her lower back and legs. The problem followed a febrile illness of sudden onset following a recent business trip to Singapore and Thailand. She had attributed the pain to a recurrence of an old problem of sciatica and was concerned that she may have been infected with swine flu. Two days before our appointment, she had visited an emergency department for pain relief and was prescribed oxycodone because Panadeine Forte was ineffective. She said that now the pains in her legs were unbearable and not responding well to opioids. Further detailed history revealed that she had associated fever, malaise, nausea, headache and generalised muscular aching. She also admitted to feeling very depressed—even suicidal. On physical examination there were no specific musculoskeletal or neurological signs (despite the severe pain), just a temperature of 38.2 °C.