Challenge and Response to Body Integrity: A Case Study Analysis

This case study examines a patient, Sue, experiencing low back pain, likely due to her profession as a fire rescue worker. The assignment delves into the physiology of pain, explaining nociception, the role of nociceptors, and the transmission of pain signals to the central nervous system. It discusses the potential causes of Sue's pain, including spinal segment tenderness, herniated discs, and facet joint enlargement. The case then explores pharmacological interventions, specifically the use of NSAIDs, detailing their mechanism of action by inhibiting the COX pathway and reducing inflammation. The summary also addresses the side effects and complications associated with NSAID use, emphasizing the importance of dosage and potential risks such as liver damage. References to relevant research articles and textbooks are provided to support the analysis of Sue's condition and its treatment.

Running head: CHALLENGE AND RESPONSE TO BODY INTEGRITY
Challenge and response to body integrity
Name of the Student
Name of the University
Author note

CHALLENGE AND RESPONSE TO BODY INTEGRITY
Physiology of low back pain
Nociception is generated when the electrical impulse enter the dorsal root ganglion via
dendrite fibre. The impulse is then accrued by the axon to the spinal cord. Nocireceptors are
responsible for transmitting impulse from site of injury as body’s physiologic response to the
central nervous system. Sue feels the pain radiating in lower back as it travels from injured
tissues to thalamocoticol neurons (Anwar, 2016). Thus, neurons connect both spinal cord and
brain, through the process of transduction, conduction, and transmission. Upon nociception,
spinal modeulation may have occurred in Sue as the electrical signals are relayed to the brain
centres. Sue feels the pain in her lower back when the brain (CNS) interprets the signals and
generates the supraspinal responses (Craft et al., 2015, pp.137-153). As per, the clinical
examination, Sue’s L3 to L4 spinal segment, positioned in the middle of the lumbar spine, was
found with tenderness and central protrusions. Injury may have occurred due to repeated
movements of neck and shoulder muscles in fire rescue services and lifting heavy weights. There
might be unwanted contact between nerve and the disc, causing herniated disc and sequentially
pain (Parker et al., 2015). The protrusions and tenderness in Sue’s lumbar spine may be due to
wear and tear of the disc, which is a degenerative cascade. The pain may also have caused by
the enlargement of the facet joints of the segment leading to stenosis. Fire rescue service
involves strenuous activity causing compression of spinal nerve roots and sequentially
degeneration (Tobert & Harris, 2018).
Pharmacological actions and effects of NSAIDS
NSAIDS are administered depending on degree of swelling, stiffness, tenderness or
pain in the area of injury, which means in dose dependent manner. Upon administration of

CHALLENGE AND RESPONSE TO BODY INTEGRITY
NSAIDS, Sue may experience decrease in back pain as well as inflammation and
consequently stiffness. The NSADIS inhibits the Cyclooxygenase (COX), pathway and
decreases pain. Central to it is Arachdoinic acid that exhibits the inflammatory effect (Bryant &
Knights, 2014, pp. 319 - 339). Sequentially, the synthesis of prostaglandin and eicosanoids are
inhibited. COX2 increases the production of Prostanoid during inflammation through cytokines
and the normal cellular process is maintained by COX1. Both play their role in inflammation,
swelling and pain. The use of NSAIDS, for Sue will help reduce the lower back pain as they
exhibit anti-inflammatory effect. Prostaglandins are primary agents in nocicpetion and
inflammation. NSAIDS like ibuprofen, Naxpoxen, aspirin, help reduce the back and neck pain
through anti-inflammatory effect (Sandilands & Bateman, 2016).
The use of NSAIDS involves complications depending on the dose and the drug used.
US FDA recommends lowest effective dose, as long as required, due to its higher efficacy
(Schilling, 2016). Different drugs vary in their toxicity level and therapeutic effects. Side
effects are usually manifested as, allergies, stomach ulcers, liver or kidney damage. In case
Sue liver damage may occur as she consumes alcohol. It may occur with administration of
acetaminophen and can be avoided if taken for short duration. Long term use of NSAIDS is
associated with greater side effects (Sandilands & Bateman, 2016).

CHALLENGE AND RESPONSE TO BODY INTEGRITY
References
Anwar, K. (2016). Pathophysiology of pain. Disease-a-Month: DM, 62(9), 324-329. Doi:
10.1016/j.disamonth.2016.05.015
Bryant, B., & Knights, K. (2015). Pharmacology for health professionals (4th Ed.). Chatswood,
N.S.W: Elsevier
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2015). Understanding
pathophysiology-ANZ adaptation. Elsevier Health Sciences. ISBN : 9780729541602
Parker, S. L., Mendenhall, S. K., Godil, S. S., Sivasubramanian, P., Cahill, K., Ziewacz, J., &
McGirt, M. J. (2015). Incidence of low back pain after lumbar discectomy for herniated
disc and its effect on patient-reported outcomes. Clinical Orthopaedics and Related
Research®, 473(6), 1988-1999. DOI: https://doi.org/10.1007/s11999-015-4193-1
Sandilands, E. A., & Bateman, D. N. (2016). Non-steroidal anti-inflammatory
drugs. Medicine, 44(3), 185-186. DOI: https://doi.org/10.1016/j.mpmed.2015.12.022
Schilling, R. (2016). Pain Treatment. Pain. Retrieved from: http://www.askdrray.com/pain-
treatment/
Tobert, D. G., & Harris, M. B. (2018). Degenerative Lumbar Spinal Stenosis and
Spondylolisthesis. In Principles of Orthopedic Practice for Primary Care Providers (pp.
47-59). Springer, Cham. DOI: https://doi.org/10.1007/978-3-319-68661-5_4