Assessment 2; Case study

This case study discusses the pathophysiology of lower back pain and the effectiveness of NSAIDs in pain management for older people. It also suggests analgesics for David.

Running head: NUR 231 1
Assessment 2; Case study
(Author’s name)
(Institutional Affiliation)

NUR 231 2
Question 1; Pathophysiology of David’s Lower Back Pain
From the MRI scan, it is obvious that the cause of David’s lower back pain is due to
metastatic lesions in thoracic and lumbar vertebrae. Most of the spinal metastasis originates from
malignant tumors and thus David might be having cancer. The metastasis spread from the
original tumor mainly through an artery and directly invades intervertebral foramina leading to
the formation of an epidural mass(Maccauro et al., 2011). This mass can cause spinal cord
distortion leading to axonal destruction and demyelination. In addition, there is a vascular
compromise which leads to edema of the spinal cord, hemorrhage and venous
infarction(Maccauro et al., 2011). This, in turn, leads to the compression of the spinal cord and
the formation of lesions. Pain originates from those lesions, inflammation, spinal distortion and
other disease processes.
Question 2a; Effectiveness of NSAIDS in pain management for older people
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used to tread various
types of acute and chronic conditions in the elderly. These drugs are effective in the treatment of
conditions such as muscle aches, osteoarthritis, back pain, pain caused by gout, and dental pain
in older people(Bolten, 2015). NSAIDs help to relieve a variety of symptoms in the above
conditions such as inflammation, pain, and stiffness caused by rheumatoid arthritis(Blondell,
Azadfard, & Wisniewski, 2013). Since elderly people are at a risk of getting joint and skeletal
problems, NSAIDs are usually prescribed since most of them are fast acting and reduce pain
quickly(Bolten, 2015). These are drugs that need to be taken between four to six hours intervals
and are usually effective for acute conditions like small injuries(“Guidance on the management
of pain in older people,” 2013). NSAIDs that need to be taken once a day are effective in the
management of chronic conditions like rheumatoid arthritis in older patients. However, NSAIDs

NUR 231 3
may increase risks of heart attack in older people. Caution needs to be taken when dealing with
patients with high blood pressure, diabetes, smoking, and high cholesterol(Bolten, 2015).
In addition to that, NSAIDs have been found to increase the risk for serious bowel and gastric
problems like bleeding and peptic ulcers which can occur without warning particularly in older
people.
Question 2b; Analgesics for David
Due to the persistence of pain, and from MRI results, David might be having cancer that
means he will need strong analgesics. These include strong opioid medications such as
morphine, oxycodone, hydromorphone or oxymorphone(“Guidance on the management of pain
in older people,” 2013). Such medications are effective in the treatment of strong pain especially
those that are cancer-related.

NUR 231 4
References
Blondell, R. D., Azadfard, M., & Wisniewski, A. M. (2013). Pharmacologic therapy for acute
pain. American Family Physician.
Bolten, W. W. (2015). NSAIDs. In Local Treatment of Inflammatory Joint Diseases: Benefits
and Risks. https://doi.org/10.1007/978-3-319-16949-1_4
Guidance on the management of pain in older people. (2013). Age and Ageing.
https://doi.org/10.1093/ageing/afs200
Maccauro, G., Spinelli, M. S., Mauro, S., Perisano, C., Graci, C., & Rosa, M. A. (2011).
Physiopathology of Spine Metastasis. International Journal of Surgical Oncology.
https://doi.org/10.1155/2011/107969