NUR231 Case Study: Pathophysiology of Lower Back Pain in John

This case study analyzes a 67-year-old businessman, John, who presented to his GP with lower back pain. The assignment explores the pathophysiology of John's pain, including tenderness over T12-L1 spine and metastatic lesions in the thoracic and lumbar vertebrae. The pain is linked to nerve irritation caused by cytokine release and bone changes. The study discusses the effectiveness of NSAIDs for pain management in older adults, highlighting their mechanism of action in blocking pain signals and their lower side effect profile. The prescribed analgesic, aspirin or ibuprofen, is supported by research showing NSAIDs' efficacy in inflammatory pain and their impact on COX enzymes. The study references several research papers to support the findings. Desklib provides this solved assignment to help students with their studies.

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

1CASE STUDY: NURSING
Answer number 1.
Reviewing the case history of the patient, on diagnosis the patient showed
tenderness over T12 –L1 spine and after two months metastatic lesion in the thoracic
and lumber vertebrae was analysed by MRI test. Looking into the pathophysiology of
the lower back, there are many nerve associated with spine and due to release of
cytokine like tumor necrosis factor-alpha and nitric oxide irritation is caused at the nerve
root, which leads to pain. Such release of cytokine is mainly because of the aging where
bone starts to lose elasticity and strength (Davis et al., 2018). The process of resorption
of osteoclast and remodeling by osteoblast become imbalanced and result of release of
TNF factor and metalloproteinase MMP-2, MMP-9, and K cathepsin. As an effect of
such, it invades the process of cell division and result in bone lesion. The pain signal
transmission become impaired due to release of neurotransmitter and cause continuous
pain (Hariri et al., 2017).
NSAIDS is effective for treating pain in the older people. It is known to block the
synapsis of the nerve end and block the transmission of the pain signa (Reid, Eccleston
& Pillemer, 2015). NSAIDS is known to have low side effect in the old people.
Answer number 2.
The prescribed analgesic after reviewing the MRI report of the patient for pain
management could be NSAIDS like Aspirin or ibuprofen. It is evident from the study of
da Costa et al. (2016) NSAIDS is effective in inflammatory pain related to bone due to
its inhibitory action on Cox enzyme. The finding is supported by the Ma et al. (2017)
where author state that inhibition of the COX-2 activity cause attenuation of the pain due

2CASE STUDY: NURSING
to bone cancer. NSAID known to function by converting Arachidonic acid to
prostaglandin, thromoxanes and prostacyclins by inhibiting the isoform of cox enzyme
(COX-2, COX-1). In turn, it also acts on the Microsomal prostaglandin E synthase-1
(mPGES-1) and inhibits its action. It is evident that mPGES-1 is isomerizes to PGE2
which can cause huge pain due to bone lesion. Thus, blockage of its activity by NSAIDS
can be effectiveness in managing the pain of the patient. It is also reported that NSAIDS
when taken in right dose and time, the probability of causing side effect is lowered in
elderly patient (Gensler et al., 2018). It is known to least effect to the metabolism of the
body, thus prescription of NSAIDS to Mr John will be helpful in managing chronic lower
back pain.

3CASE STUDY: NURSING
Reference
da Costa, B. R., Reichenbach, S., Keller, N., Nartey, L., Wandel, S., Jüni, P., & Trelle,
S. (2016). Retracted: effectiveness of non-steroidal anti-inflammatory drugs for
the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.
https://doi.org/10.1016/S0140-6736(16)30002-2
Davis, G., Lee, M., Aregawi, D., Shaffrey, M. E., Schiff, D., & Sherman, J. H. (2018).
Spinal Metastasis as Complication of Systemic Cancers. In Cancer Neurology in
Clinical Practice(pp. 113-125). Springer, Cham. https://doi.org/10.1007/978-3-
319-57901-6_6
Gensler, L. S., Gianfrancesco, M., Weisman, M. H., Brown, M. A., Lee, M., Learch,
T., ... & Ward, M. M. (2018). OP0198 Combined effects of tumour necrosis factor
inhibitors and nsaids on radiographic progression in ankylosing spondylitis.
http://dx.doi.org/10.1136/annrheumdis-2018-eular.4027
Hariri, O., Takayanagi, A., Miulli, D. E., Siddiqi, J., & Vrionis, F. (2017). Minimally
invasive surgical techniques for management of painful metastatic and primary
spinal tumors. Cureus, 9(3). https://dx.doi.org/10.7759%2Fcureus.1114
Ma, S., Yada, K., Lee, H., Fukuda, Y., Iida, A., & Suzuki, K. (2017). Taheebo
polyphenols attenuate free fatty acid-induced inflammation in murine and human
macrophage cell lines as inhibitor of cyclooxygenase-2. Frontiers in Nutrition, 4,
63. https://doi.org/10.3389/fnut.2017.00063
Reid, M. C., Eccleston, C., & Pillemer, K. (2015). Management of chronic pain in older
adults. Bmj, 350, h532. https://doi.org/10.1136/bmj.h532