NUR231 Case Study: Jack, Pain Threshold and Treatment Strategies

This case study analyzes the case of Jack, a 68-year-old construction worker experiencing lower back pain. The assignment addresses the changes in pain threshold and behavioral responses in older adults, and discusses the use of NSAIDs and opioid treatments. Jack's case involves a progression from initial treatment with NSAIDs to the consideration of opioid treatment due to worsening pain and the discovery of metastatic lesions. The analysis explores the effectiveness of different analgesic medications, including opioids, and considers the need for additional treatments like anticonvulsants and antidepressants in cases of spinal metastasis. The document provides a comprehensive overview of pain management strategies, considering the specific needs of elderly patients and the complexities of chronic pain conditions.

Running head: CASE STUDY
CASE STUDY
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1CASE STUDY
Answer 1.
The pain threshold can be described as the maximum level of pain that can
be tolerated by an individual. The older people are considered to have lower pain
tolerance compared to the younger people. Thus the pain threshold is low in case of
the older individuals. The behavioural response to pain can be complaining about the
pain, displaying agonised facial expression, anxiety and even negative thoughts
about their survival (Malara et al., 2016).
The NSAID medications are the first choice of medications that are used in
the elderly patients. The drug acts by inhibiting the cyclooxygenase enzyme action.
As a result of that phenomenon, the synthesis of a few bio-mediators involved in the
inflammatory response gets affected and as a result the individuals do not
experience the pain (Ghlichloo & Gerriets, 2019). The medication is effective if it is
used for a short time and in very low dose in the elderly patients (Ali et al., 2018).
Answer 2.
Analgesic medications are also known as the “pain killers”. The medication is
only used for the management of the pain in the patients. There are mainly three
types of analgesics that are normally used in the pain management. The first one of
them is the opioid medications, which are mainly used for the long term pain
management (Cohen & Preuss, 2019). The second type of analgesic can be the
NSAID medications, which are used for short term management of pain. These
drugs are also used for the chronic pain management on the patients (Ghlichloo &
Gerriets, 2019). The third type of analgesics are known as Acetaminophen. These
drugs are used for short-term and mild pain management (Gerriets & Nappe, 2019).

2CASE STUDY
Jack is experiencing a lower back pain that is unresponsive to the NSAID
medications. The pain is also persistent. Thus he should be prescribed with an
opioid treatment. It has been found from the studies that the analgesic treatment
therapy, especially the opioid treatment is effective in case of bone metastasis
(Ahmad et al., 2018). However, the pain associated with the spinal metastasis can
also be a neuropathic pain. Only analgesic treatment therapy has been found to be
less effective in this kind of pain management. The study suggests that a use of
anticovulsants and antidepressants along with the opioid treatment can be effective
for a successful pain management in the patients with spinal metastasis condition
(Guan, Tanaka & Kawakami, 2016). Hence, it can be decided that Jack should be
prescribed with anticovulsants and antidepressants along with the opioid
medications.

3CASE STUDY
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). doi: 10.7759/cureus.3286
Ali, A., Arif, A. W., Bhan, C., Kumar, D., Malik, M. B., Sayyed, Z., ... & Ahmad, M. Q.
(2018). Managing chronic pain in the elderly: an overview of the recent
therapeutic advancements. Cureus, 10(9). doi: 10.7759/cureus.3293
Cohen, B., & Preuss, C. V. (2019). Opioid Analgesics. In StatPearls [Internet].
StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459161/
Gerriets, V., & Nappe, T. M. (2019). Acetaminophen.
https://europepmc.org/article/NBK/NBK482369
Ghlichloo, I., & Gerriets, V. (2019). Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
https://www.ncbi.nlm.nih.gov/books/NBK547742/
Guan, J., Tanaka, S., & Kawakami, K. (2016). Anticonvulsants or antidepressants in
combination pharmacotherapy for treatment of neuropathic pain in cancer
patients: a systematic review and meta-analysis. The Clinical journal of
pain, 32(8), 719-725. doi: 10.1097/AJP.0000000000000310
Malara, A., De Biase, G. A., Bettarini, F., Ceravolo, F., Di Cello, S., Garo, M., ... &
Rispoli, V. (2016). Pain assessment in elderly with behavioral and
psychological symptoms of dementia. Journal of Alzheimer's Disease, 50(4),
1217-1225. DOI: 10.3233/JAD-150808