NUR231 Assessment 2: Case Study Solution on Pain Management

This case study analyzes the presentation of a 68-year-old construction worker, Jack, who presented with lower back pain, leading to a diagnosis of metastatic lesions in his spine. The assignment addresses two key questions: firstly, the changes in pain threshold and behavioral responses to pain in older adults, and secondly, the treatment options for spinal metastases, including analgesic drugs like opioids and bisphosphonates. The solution details the mechanisms of pain, the factors affecting pain management in the elderly, and the role of various medications in alleviating pain and managing the condition. It references relevant literature to support the discussion of these complex medical issues and adheres to APA 7th edition referencing guidelines.

Running head: CASE STUDY
CASE STUDY
Name of the Student
Name of the University
Author Note

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ANSWER NO. 1.
The minimum pain stimulation or lowest intensity that initiates the pain response
in the body is referred to as pain threshold. It is generally persistent for a given stimulus.
The effectiveness of stimulus various from subject to subject. Pain is enhanced due to
sensitivity of pressure in older age. Chronic pain is associated with age due to alternation
states of central or peripheral mechanism of pain along with restricted movement, mood
swings and sleeping problems (El Tumi et al., 2017). The condition is worsened due to poor
management of pain among this group of people. The factors due to which proper
management fails to happen are lack of knowledge and fear to consume medications, lack
of acceptance of the provided treatment. The pain management depends upon the
behavioural skill of the patient; the management is done by coping and intellectual skills
that are highly essential in giving treatment plans. The behavioural therapy can be given to
older patients with good memory along with relaxation therapy. The analgesics reduce the
production of the hormone prostaglandins by blocking the cyclooxygenase enzyme, which is
responsible for the formation of thromboxane and prostaniods. It is used in older patient in
management of osteoarthritis pain (Leri, 2018).
ANSWER NO. 2.
The metastatic refers to the condition where the origin of cancer spreads from
one part of the body to another. Spinal metastases is also refers to as primary malignancy.
The defect that are found below the lesion is mainly consists of neurological signs such as
loss in sensory function, loss of motor function, weakness of bones and muscles. The patient
suffering from this condition commonly consists of compression fractures with cervical spine
fracture. It is the initial sign of spinal metastasis. The low back pain symptom is common

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among patient with vertebral tumour, the main cause of this pain can be effect of tumour
in the spinal cord nerve roots and blood vessels (Mabry, Ross & Tonarelli, 2014). It pain
originates from the site of the tumour and spreads to all the parts of the body and lead to
loss of muscle and nerve sensations. The opioids analgesic can be given to the patient in
this case. The drug has a long-term effect. Primarily analgesics works by blocking the brain
signals and interpretations of those signals. The class of drugs includes levorphanol,
methadone, phenazocine, morphine. The drug acts by two components supraspinal and
spinal which inhibits the secretion of transmitters from the primary afferents nerves such as
from substantia gelatinosa. The drug decreases the transmission of pain impulse from
cortex, midbrain and medulla. The receptor that takes place in desensitization is N-methyl-
D-aspartate (NMDA) receptors (Ahmad et al., 2018). The drug has many side effects such as
constipation, vomiting, nausea, addiction and sedation. The drug has serious effect for its
prolonged use. The bisphosphonates are also used in this to cure hypercalcemic condition of
the body.

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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
El Tumi, H., Johnson, M. I., Dantas, P. B. F., Maynard, M. J., & Tashani, O. A. (2017). Age‐
related changes in pain sensitivity in healthy humans: A systematic review with
meta analysis.‐ European Journal of Pain, 21(6), 955-964.
Leri J. P. (2018). Metastatic Cancer of the Thoracic and Lumbar Spine Presenting as Mid- and
Low Back Pain in a Long Distance Runner. Journal of chiropractic medicine, 17(2),
121–127. https://doi.org/10.1016/j.jcm.2017.11.004
Mabry, L. M., Ross, M. D., & Tonarelli, J. M. (2014). Metastatic cancer mimicking mechanical
low back pain: a case report. The Journal of manual & manipulative therapy, 22(3),
162–169. https://doi.org/10.1179/2042618613Y.0000000056

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