Charles Darwin University: NUR231 Case Study - Back Pain Assessment

This assignment is a case study analyzing the back pain experienced by a 71-year-old man named David. The study delves into the pathophysiology of his lower back pain, which was caused by metastatic lesions in the lumbar and thoracic vertebrae. The analysis explains how tumor cells disrupt bone remodeling, leading to pain. The assignment then discusses the effectiveness of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for pain management in older adults, highlighting their anti-inflammatory properties and relative safety. Finally, it addresses the appropriate analgesics to prescribe David, given his persistent pain and the MRI results. The solution recommends paracetamol and opioids like morphine and codeine, emphasizing their role in cancer pain management.

Running head: ASSESSMENT OF BACK PAIN
ASSESSMENT OF BACK PAIN
Name of the student:
Name of the University:
Author note:

1ASSESSMENT OF BACK PAIN
Q1) Explain the pathophysiology of David’s lower back pain.
David was suffering from lower back pain due to metastatic lesions in lumbar and
thoracic vertebra of spinal cord. Bone is considered as the most common site for metastasis
and spinal cord is the common area considered for the metastatic deposits (George et al.,
2015). The spinal bone undergoes a constant resorption process because of remodelling due
to osteoblast. In a healthy person, the process is normal and balanced while in metastatic
person, the cells loses balance and create a mixed lesions known as osteoblastic lesions
(Kumar et al., 2017). These lesions developed due to tumour cells, by creating a
disequilibrium in the osteolytic activity of the bone. Once the tumour cells have conquered
the bone, different growth factors will be released, which will lead to bone destruction and
development of local tumour. Hence, this invasion of tumour cells in the spinal bone results
in severe back pain of the patient (Ropper & Ropper, 2017).
Q2) A) Discuss the effectiveness of NSAIDS for pain management in older people.
Nonsteroidal anti-inflammatory drugs (NSAIDs) is considered as one of the best class
of drug for pain management in older people. Ibuprofen and aspirin are some of the
common drugs in NSAIDs. Anti-inflammatory effect is exhibited by NSAIDs, which is effective
in case of older people (Money & Garber, 2018). The opioid-associated and central nervous
system (CNS) associated side effects are exhibited in NSAIDs making it effective for elders to
consume during acute pain. The drug is considered safe for the patients with rapid onset for
quick relief. The drug has no major side effect even if high dose is consumed by older people
for effective pain management (Malec & Shega, 2015).

2ASSESSMENT OF BACK PAIN
Q2) B) Following the MRI report, and the pain being persistent, which analgesics should be
prescribed to Mr David?
According to the magnetic imaging resonance (MRI), the pain was persistent in the
patient and was recommended to consume paracetamol. Since, the cancer pain is very
persistent and constant; an effective medication relief is suggested to be used by the
patient. Medicines such as opioid drugs and paracetamol is recommended (Kerr, 2016).
Paracetamol is an important or crucial pain control drug, which is tolerated well by the
patient body. This drug will not affect the intensity of blood by making it thinner and will not
affect the stomach. It is especially recommended for very age people as it quickly relieves
bone pain and reduce fever (Kolettas et al., 2015). For the best effective and faster result,
paracetamol can be consumed in parallel with opioids. Hence, other than NSAIDs, the
patient should be prescribed with analgesics such as paracetamol and opioids like morphine
and codeine.

3ASSESSMENT OF BACK PAIN
References
George, R., Sundararaj, J. J., Govindaraj, R., Chacko, A. G., & Tharyan, P. (2015).
Interventions for the treatment of metastatic extradural spinal cord compression in
adults. Cochrane Database of Systematic Reviews, (9).
Kerr, C. L. (2016). Pain management I: systemic analgesics. In BSAVA manual of canine and
feline anaesthesia and analgesia (pp. 124-142). BSAVA Library.
Kolettas, A., Lazaridis, G., Baka, S., Mpoukovinas, I., Karavasilis, V., Kioumis, I., ... & Pataka, A.
(2015). Postoperative pain management. Journal of thoracic disease, 7(Suppl 1), S62.
Kumar, A., Weber, M. H., Gokaslan, Z., Wolinsky, J. P., Schmidt, M., Rhines, L., ... &
Sundaresan, N. (2017). Metastatic spinal cord compression and steroid treatment.
Clinical spine surgery, 30(4), 156-163.
Malec, M., & Shega, J. W. (2015). Pain management in the elderly. Medical Clinics, 99(2),
337-350.
Money, S., & Garber, B. (2018). Management of cancer pain. Current Emergency and
Hospital Medicine Reports, 6(4), 141-146.
Ropper, A. E., & Ropper, A. H. (2017). Acute spinal cord compression. New England Journal
of Medicine, 376(14), 1358-1369.