Healthcare Case Study: Pathophysiology, Analgesics for Lower Back Pain

This case study analyzes a 67-year-old businessman's lower back pain, starting with his initial presentation to his GP and progressing through diagnosis with MRI revealing metastatic lesions. The assignment addresses the pathophysiology of the pain, originating from somatic nociceptive activity in the thoracic and lumbar spine and the role of molecular pain mediators. It also discusses the effectiveness of NSAIDs for pain management in older people, considering age-related variances and potential adverse effects. Furthermore, it explores the use of analgesics, including paracetamol, topical diclofenac, and naproxen, in managing the patient's pain, while also mentioning the potential use of opioids and bisphosphonates as adjuvant treatments. The study emphasizes a stepwise approach to pharmacological interventions, adhering to WHO guidelines to alleviate pain and minimize complications.

Running head: CHALLENGE INTO BODY INTEGRITY 1
Challenge into Body Integrity
Name
Institutional Affiliation

CHALLENGE INTO BODY INTEGRITY 2
1. Pathophysiology
Mr. David has localized chronic lower back pain from somatic nociceptive activity that
originates from thoracic and lumbar spine caused by internal damage. The vertebral lesions
affect the molecular pain mediators like chemokines, protons, neurotrophins and ATP (Finucane,
2013). The multimodal messaging takes place through chemical or molecular of pain as part of
the nociception neural endings innervating periosteum via spinal dorsal horn neurons, which is
activated by stimuli to a bone (Finucane, 2013).
The metastatic lesions might develop through tumour cells alongside bone interacting via
a process like embolization and vascularization that disrupt normal repair of skeletal (Aielli,
Ponzetti & Rucci, 2019). Nociceptors in the spinal areas before the differing MRI outcome might
have had a causal reason of the degenerated disc, lesions, inflammation, or mechanical injury
arising from the benign aneurysmal bone cysts or ABCs (Finucane, 2013).
Using NSAIDs supports reduction of pain with safe therapeutic use in elderly population.
Minimal, but consistent relief of symptoms remains feasible with intervention of up to 3-months
in mild to moderate reported pain. Variances to psychology rises with increase in age, hence
adverse effects (AE) with NSAIDs utilization surges (Enthroven, Roelofs, & Koes, 2017).
Elderly population need individualized treatment planning, accounting for
gastrointestinal (GE) tolerability, surged probability of polypharmacy/contraindications and
reduced adaptive motility, blood movement, secretions, and surface degradation when NSAIDs
is being prescribed. Adverse effects like GE bleeds, cardiac and respiratory distress and toxic
buildup linked to NSAIDs might counter gains of proven pain reduction effectiveness.
2. Analgesics

CHALLENGE INTO BODY INTEGRITY 3
Mr David's pain is progressing in severity while becoming chronic at the time of the MRI
outcome thus the practitioners must consult more to support the use of analgesics (Walker,
2012). Thus, combining analgesics might remain useful in providing optimal pain relief as well
as minimizing breakthrough pain (Aielli et al. 2019). The guidelines set out by the WHO should
be followed in the step-wise approach to pharmacological interventions will relieve his pain like
majority of patients and lowering the complications rates. Thus, paracetamol, antipyretic
analgesic has low gastric side-effects with restrained anti-inflammatory effect (Aielli et al., 2019.
The topical utilization of diclofenac will minimize AE linked to oral dose NSAIDs while
giving anti-inflammatory effect in case Mr David continue with cycling and walking, the
movement remains a non-pharmacological analgesic mechanism which supports better mental
health, reduce stress and overall health (Finucane, 2013). The Naproxen, OX-1/COX-2 inhibitor,
is also an alternative in case the pain is moderate since it is slow release (Aielli et al., 2019).
The Opioid choice needs to be dependent on pharmacokinetic consideration, maybe
originally codeine or, yet more probably, morphine orally administered (Ghosh & Berger, 2014).
Whereas not analgesics, prophylaxis will also be needed for potential side-effects like
constipation and nausea in case Mr David shows such symptoms (Finucane, 2013).
Bisphosphonate will also be used as the adjuvant for the anti-reabsorptive effect to limit lesion
formation.

CHALLENGE INTO BODY INTEGRITY 4
References
Aielli, F., Ponzetti, M., & Rucci, N. (2019). Bone metastasis pain, from the bench to the bedside.
International Journal of Molecular Sciences, 20 (2): doi: 10.3390/ijms20020280.
Enthroven, W. T.M., Roelofs, P. D., & Koes, B. W. (2017). NSAIDs for chronic low back pain.
JAMA, The Journal of the American Medical Association, 317(22), 2327-2328.
doi:10.1001/jama.2017.4571
Finucane, L. (2013). Metastatic disease masquerading as mechanical low back pain; atypical
symptoms which may raise suspicion. Manual Therapy, 18 (6), 624-627.
Ghosh, A., & Berger, A. (2014). Opioids, adjuvants, and interventional options for pain
management of symptomatic metastases. Annals of Palliative Medicine, 3(3), 172-191.
doi:10.3978/j.issn.2224-5820.2014.07.07
Walker, J. (2012). Back pain: pathogenesis, diagnosis and management. Nursing Standard,
27(14), 49-56. doi:10.7748/ns2012.12.27.14.49.c9478.
doi:10.1016/j.math.2013.02.009.