Case Study: Optimizing Pain Relief for Elderly with Metastatic Lesions

This case study examines the pain management strategies for a 68-year-old construction worker, Mr. Jack, who presented with lower back pain and was later diagnosed with metastatic lesions in his thoracic and lumbar vertebrae. The analysis addresses the altered pain threshold and behavioral response to pain in elderly individuals, highlighting the cautious use of NSAIDs due to potential side effects. Given the severity of Mr. Jack's pain, the case study suggests a prescription of opioid drugs, possibly supplemented with tricyclic antidepressants, to effectively manage the cancer-related pain. The discussion references existing literature supporting the use of opioids for severe pain management in cancer patients and emphasizes the importance of tailoring the treatment approach to the individual's specific needs and condition. Desklib is a platform where students can find similar solved assignments.

Challenge and response to body integrity
1. What happens to pain threshold and behavioural response to pain in the older people
and discuss briefly the effectiveness of NSAIDs for pain management in the elderly?
Pain is the common health issue faced by most of the elderly people. The prevalence shows
that pain in elderly people, particularly who are aged above 60 suffers double folded pain
compared to younger people. The sensory threshold for stimuli increases with age in elderly
people. Pain threshold significantly impacts the pain tolerance of the aged people. NSAIDs
are the common pain management strategy used for elderly people (McCarberg, 2013).
Especially, aged people above the age of 65 can take NSAIDs for low back pain. The side
effects are also limited when compared to other pain management strategy. NSAIDs are
considered as safest pain medication which can be used for a longer duration. Chronic
conditions like diabetes, hypertension, and cardio-vascular are common in elderly people,
NSAIDs medications dose not impact the chronic conditions. NSAIDs are cost-effective,
which are considered as affordable pain management for Jack who is the construction worker.
2. Following the MRI report, and the pain being persistent, which analgesics should be
prescribed to Mr Jack? Support your answer with evidence.
Metastatic lesions in thoracic and lumbar vertebrae show that Mr Jack is suffering from
cancer. Carcinoma is a significant disease condition comprises of severe pain. Pain impacts
the physical, emotional status of a person. As the pain threshold is high and tolerance is low
in elderly people, the pain management needs to be implemented as per the need of the
suffering person (Delank, Wendtner, Eich, & Eysel, 2011). According to the implication of
the World Health organisation, the pain management for elderly persons is implemented
based on the degree of pain. Generally, elderly patients are prescribed with the non-steroidal
anti-inflammatory drug for mild and moderate pain. Some of the patients who suffer severe

pain due to cancer-associated with various other complications are prescribed with Opioid
drug.
In the case of Mr Jack, the pain was severing according to the severity of the disease. The
opioid drug is the only drug of choice for pain management in patients with cancer pain.
Opioid drugs are most effective which comprises of durable analgesic effect. According to
the literature review of Ahmad et al. (2018), 80% of cancer patients are using Opioid drugs to
control the pain. The analgesic effect of the drug is due to μ-receptor saturation which modifies
according to the type and severity of pain. Tri-cyclic Antidepressants are considered as the
second common drug to treat bone pain among elderly people. This drug balances the mood
and induces sleep to make the person relax. Tri-cyclic Antidepressants are used for patient
with cancer in an advanced stage. Opioid drugs and Tri-cyclic Antidepressants can be
prescribed to Mr Jack in the process of pain management.

References
Ahmad, I., Ahmed, M. M., Ahsraf, M. F., Naeem, A., Tasleem, A., Ahmed, M., & Farooqi,
M. S. (2018). Pain Management in Metastatic Bone Disease: A Literature
Review. Cureus, 10(9), e3286. https://doi.org/10.7759/cureus.3286
Delank, K. S., Wendtner, C., Eich, H. T., & Eysel, P. (2011). The treatment of spinal
metastases. Deutsches Arzteblatt international, 108(5), 71–80.
https://doi.org/10.3238/arztebl.2011.0071
McCarberg, B. H. (2013). NSAIDs in the older patient: balancing benefits and harms. Pain
Medicine, 14(suppl_1), S43-S44
https://academic.oup.com/painmedicine/article/14/suppl_1/S43/1941495