Case Study Analysis: Metastatic Lesions, Pain Management in Elderly

This case study focuses on a patient, Mr. David, diagnosed with metastatic lesions in the thoracic and lumbar vertebrae, causing lower back pain. The assignment explores the pathophysiology of bone metastasis, highlighting how cancer cells disrupt bone homeostasis and induce pain. It also examines the effectiveness of NSAIDs in older adults, including both benefits and potential side effects. Furthermore, the case study discusses appropriate pain management strategies for Mr. David, recommending corticosteroids and other adjunct treatments such as calcitonin, α2-Adrenergic Agonists, bisphosphonates, gabapentin, Pregabalin, amitriptyline or carbamazepine. The assignment references relevant research articles on vertebral compression fractures and spinal analgesia for cancer pain.

Running head: REVIEW OF CASE STUDY
REVIEW OF CASE STUDY
Name of Student:
Name of University:
Author’s Note:

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REVIEW OF CASE STUDY
Answer no 1
The major reason for lower back pain in Mr David is metastatic lesions in thoracic and
lumbar vertebrae. The Metastasis in bone arises by the transport of neoplastic cell from primary
site and travel intravenously into the blood and reach bone marrow and starts to divide. The
diffusion of cancer cell in spinal is mostly through venous system. The balance of bone
resorption by osteoclast is lost and lesion is created by stimulation of osteoclastic activity linked
with reduced osteoblastic activity. The lesion in thoracic and lumbar vertebrae causes increase in
bone formation associated with unbalanced osteolytic activity. After invasion of cancer cell in
bone, it starts to produce growth factor that result in malicious cycle of bone destruction. This
make the bone weak and fragile and cause frequent pain in people. Further, with damage of bone
cell, calcium is released into blood stream may cause instability and injury to neurons (Faruqi et
al., 2017)
Answer no 2 (a)
The basic effectiveness of NSAIDs in management of pain in older people are limited
however, it has some known benefits also. NSAIDs is best recognized to prevent the cause of
dementia in older people as they interact with neurological behavior of them. NSAIDs improves
and enhance the muscle performance in older people. Evidence from research suggested that
older people taking NSAIDs maintain the continence of urine, thereby improves excretory
system in them. Older people who suffers from cancer, takes NSAIDs is identified to be
effective, as it reduces the pain due to lesions in tissues. NSAIDs is known to be effective in
treating inflammatory pain in people. They are used over acetaminophen as it is more operative
in treating pain. In older people who takes NSAIDs does not face the problem of respiratory

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depression. However, it will be more useful if administered in low dose because high dose can
cause serious lethal side effects in older people (Money & Garber, 2018).
Answer no 2 (b)
After the MRI report Mr David was diagnosed with cancer in thoracic and lumbar
vertebrae and he was still having pain in lower back. The analgesics prescribe to him should be
corticosteroids as it is most effective drug for pain management in cancer patients. Some
example are dexamethasone and methylprednisolone. Other drug in accompanied with
corticosteroids can be calcitonin, α2-Adrenergic Agonists, bisphosphonates. Additionally, other
analgesic that can be given to him may be gabapentin, Pregabalin, amitriptyline or
carbamazepine (Kiehelä, Hamunen & Heiskanen, 2017).

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Reference
Faruqi, S., Tseng, C. L., Whyne, C., Alghamdi, M., Wilson, J., Myrehaug, S., ... & Fisher, C.
(2017). Vertebral compression fracture after spine stereotactic body radiation therapy: A
review of the pathophysiology and risk factors. Neurosurgery, 83(3), 314-322.
Kiehelä, L., Hamunen, K., & Heiskanen, T. (2017). Spinal analgesia for severe cancer pain: A
retrospective analysis of 60 patients. Scandinavian journal of pain, 16, 140-145.
Money, S., & Garber, B. (2018). Management of cancer pain. Current Emergency and Hospital
Medicine Reports, 6(4), 141-146.