The first consultationMr N, a 40-year-old policeman, came to the primary care clinic having had intermittent episodes of low back pain for the past year. His back pain usually occurred once a month and was relieved by a short duration of analgesia. He had only once sought treatment from a general practitioner three months before. A simple imaging was carried out but there was no identifiable cause for his low back pain. At this visit, his back pain had persisted for five days. The pain was similar to the other back pain instances which he had suffered over the past year. He also complained that for the past three months he had had more episodes of back pain as his workload as a police traffic officer had increased. The main precipitating factors were prolonged standing, walking and lifting heavy loads. He had been absent from work for each episode of back pain. He denied any history of fall or trauma. There was no history to suggest malignancy, renal calculi,tuberculosis or connective tissue disease.During the consultation, he appeared pleasant and his gait was normal. His body mass index was 24.7, which is mildly overweight. His neurological and spinal examinations were unremarkable. There was no abnormality noted during the clinical examination.Based on the clinical evaluation, the diagnosis of non-specific backache was made. He was then treated conservatively with analgesia and physiotherapy. Advice on back care was given to him. He was also given a memo for light duty for about six weeks. This was to reduce his workload, especially that involving lifting of heavy loads and prolonged standing.Following visitsThe patient returned to the clinic after eight weeks. He had stopped attending the physiotherapy as he was busy with his job. His back pain still had not improved. During this consultation, Mr N was not as cheerful and talkative as before. His voice was soft and his tone was low. He appeared sad and his eye contact was poor. He kept looking down to the floor with a lot of sighing and pauses during the conversation. Although the visit was originally scheduled to discuss the treatment of back pain, the primary care physician had to focus on exploring reasons for the sudden change in his behaviour.During the consultation, he admitted that his mood had been low for the past month. He had lost weight and his sleep was affected. He denied hearing any voices or having suicidal thoughts. He claimed that he felt guilty as he was a burden to his colleagues. In addition, he was facing financial difficulties as he had to settle his younger brother's debts to loan sharks. He was still able to go to work but was having difficulty concentrating and completing the tasks given to him. He was diagnosed with major depression and an antidepressant was commenced. He also received cognitive behavioural counselling and relaxation therapy.Six months later, his mood had tremendously improved. He had been compliant with his medication and monthly follow-up. He still experienced a few episodes of back pain butthe frequency and intensity were less. He was more cheerful and able to cope with his back pain with physiotherapy and back massages. He was no longer feeling guilty and was able to socialize. He felt that his relationship with his family and colleagues had improvedQuestions and Activities:1. What causes the pain of the patient? Define the different types of pain. Based on the Clinical Case Scenario above, what kind of pain that the patient has? Support your answer with the manifestation that the patient is experiencing.2. Discuss the Nociception Theory. Cite your references.3. What are the different guidelines / tools that can help a nurse practitioner to assess a patient who is in pain? Cite your references.4. Provide your Top 2 Nursing Diagnosis and create 2 Nursing Care Plan. Kindly follow the format as recommended.

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Depression is a group of conditions which is related with the elevation or lowering of  an…