Challenge and Response to Body Integrity: David's Case Study

This assignment analyzes the case of David, a 71-year-old man experiencing lower back pain. The first part explains the pathophysiology of David's pain, focusing on the potential involvement of spinal metastasis and the mechanisms of bone destruction and radiculopathy. The second part discusse...Read More

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
1) As per the case study, it is evident that David’s pain is in the inguinal region and the
medial thigh region. The spinal cord travels from the base of the skull through the spinal
column and ends at about T12-L1, where the thoracic spine meets the lumbar spine. At
this point there are numerous nerve roots that continue down and branches out (de
Schepper et al., 2012). Pain in the lower back region can be caused by bones and spine
metastasis. The cancer metastasizes in the bones by different means of propagation. The
bone tissue undergoes re-adsorption of the osteoclasts and the remodelling (Wallace,
Greenwood & Jennings, 2015). In the normal individuals the entire process is balanced,
but in cancer cells this balance is lost leading to the formation of lytic, thickened lesions
causing bone destruction. Due to tumour radiculopathy might occur as band like pain
due to neuroforaminal compression by the tumour in the lumber region (Allegri et al.,
2016). The pain might occur while bearing weight and is relieved while lying down.
2. A) Persistent pain in older people might lead to impaired physical function and might also
contribute to homeostenosis. NSAIDs are frequently used in elderly patients to treat
neuralgia. They are used frequently due to their safety, relatively low cost and its easy
availability over the counter. NSAIDs are useful in tissue injury or other inflammatory
conditions especially in metastatic cancer because of the anti-inflammatory effect and
the can also reduce the cancer growth. NSAIDs works at a chemical level. They work by
blocking Cox- 1 and cox 2 enzymes, thus restricting the release of the prostaglandins,
thus reducing the pain. Nowadays only Cox- 2 inhibitors are used that does not restrict
Cox- 1 (Swarm et al., 2013). Discussing about the contraindication of the NSAIDs, The
NSAIDs related gastrointestinal toxicity increases with age. NSAIDs should not be used by
the elderly if the patient shows hypersensitivity to the drug. There are risks of

Challenge and response to body integrity
gastrointestinal bleeding or decreased kidney function and decreased platelet function.
The most widely used painkiller is aspirin, which is still used against many inflammatory
painful condition as it inhibits the platelet contribution to blood clotting and small doses
of aspirin might prevent strokes and coronary artery occlusion (Marras & Leali, 2016).
However, there had been arguments as the administration of NSAIDs is indicated for a
time period of 3-5 weeks and the drug lacks effectiveness for chronic pain. Increased pain
intensity and ineffective pain indicates the need to introduce opioids (Wilson, Stack &
Hester, 2014). NSAIDs can be used alone or in combination with the opioids, if they are
not very effective if used alone.

Challenge and response to body integrity
References
Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., … Fanelli, G.
(2016). Mechanisms of low back pain: a guide for diagnosis and therapy.
F1000Research, 5, F1000 Faculty Rev-1530. doi:10.12688/f1000research.8105.2
de Schepper, E. I., Damen, J., Bos, P. K., Hofman, A., Koes, B. W., & Bierma-Zeinstra, S. M.
(2012). Disk degeneration of the upper lumbar disks is associated with hip pain.
European spine journal : official publication of the European Spine Society, the
European Spinal Deformity Society, and the European Section of the Cervical Spine
Research Society, 22(4), 721–726. doi:10.1007/s00586-012-2559-6
Maccauro, G., Spinelli, M. S., Mauro, S., Perisano, C., Graci, C., & Rosa, M. A. (2013).
Physiopathology of spine metastasis. International journal of surgical oncology,
2013.
Marras, F., & Leali, P. T. (2016). The role of drugs in bone pain. Clinical cases in mineral and
bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral
Metabolism, and Skeletal Diseases, 13(2), 93–96.
doi:10.11138/ccmbm/2016.13.2.093
Swarm, R. A., Abernethy, A. P., Anghelescu, D. L., Benedetti, C., Buga, S., Cleeland, C., ... &
Kamdar, M. M. (2013). Adult cancer pain. Journal of the National Comprehensive
Cancer Network, 11(8), 992-1022.

Challenge and response to body integrity
Wallace, A. N., Greenwood, T. J., & Jennings, J. W. (2015). Radiofrequency ablation and
vertebral augmentation for palliation of painful spinal metastases. Journal of neuro-
oncology, 124(1), 111-118.
Wilson, J., Stack, C., & Hester, J. (2014). Recent advances in cancer pain management.
F1000prime reports, 6.