“I just need something for my back and my temper”

A veteran presenting with back pain, insomnia and "a short fuse" is often PTSD wearing a somatic, acceptable mask — the nightmares, flashbacks, hypervigilance, avoidance, numbing, irritability, heavy drinking and relationship breakdown are the real picture. The tasks: recognise PTSD behind the physical complaints, assess risk sensitively (suicide — veterans are higher-risk — risk to others given escalating anger, and any risk around the children), refer to evidence-based and veteran-specific care (Op COURAGE; individual trauma-focused CBT per NICE NG116 — NG116 recommends EMDR only after non-combat-related trauma, so EMDR is the wrong offer for combat-related PTSD) plus alcohol support (NICE CG115), and prescribe wisely (not benzodiazepines/opioids that entrench dependence; NICE NG59: no opioids for chronic low back pain; NICE NG116: venlafaxine or an SSRI such as sertraline if he prefers medication). The examinable hidden agenda is shame and identity: he believes help-seeking means he’s "broken" and has failed the soldier’s code, fears losing his strong-one identity, and has removed himself from his children to protect them from his anger. A trauma-informed, respectful, patient-led pace that reframes help as strength and names PTSD as a normal injury of abnormal experience is what earns the trust to engage him — not another tablet, and not being "passed around".