Case Study: Managing Pain from Metastatic Lesions in Older Adults

This case study addresses the pathophysiology of lower back pain in a 71-year-old man, David, who was diagnosed with metastatic lesions in his thoracic and lumbar vertebrae. Initially treated with non-steroidal anti-inflammatory drugs (NSAIDs), the case explores the effectiveness and potential adverse outcomes of NSAIDs for pain management in older adults, particularly considering the risks of hypertension, GI toxicity, renal malfunction, heart failure, and cardiovascular events. The study contrasts NSAIDs with alternative analgesics like morphine, acetaminophen, and ibuprofen, noting morphine's effectiveness for pain relief in spine metastasis while acknowledging potential side effects such as vomiting, nausea, and dizziness. The case emphasizes the importance of starting with low dosages and titrating medication according to individual needs to minimize adverse effects in older patients.

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Pathophysiology of David’s lower back pain.
David is an old man of age 71 years and is a very active person who actively practices
walking, cycling and other physical activities. But for past 2 months he has been experiencing
severe pain in his lower back portion and it has been increasing gradually with increasing
time. he consulted his general physician and found out acute tenderness over the T12-L1 but
did not find any other clinical symptoms or signs. He was then asked to perform MRI of his
spine and after which he found out that he has been suffering from metastatic lesions in
thoracic and lumbar vertebrae. Before he was diagnosed with spine metastasis, the general
physician administered him with non-steroidal anti-inflammatory medication. The medication
as prescribed can cause severe side effect for a person of his age, but a he was witnessing
sever pain, he was provided with the drug by his GP.

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The effectiveness of NSAIDS for pain management in older people
The effectiveness of NSAIDS for pain management in older people can show an
adverse outcome. An older person experiencing lower back pain has a high risk of side
effects of all drugs and medications provided with which includes analgesics such as
nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs also are not preferred for people
suffering from any kind of kidney, liver or heart disorders and must not be consumed without
the recommendation of the doctor (Reid, Eccleston & Pillemer, 2015). As these analgesic
doses do not adjust with the age and the physiology of elder people therefore, the best way to
prescribe these medications are to start with low dosage and titrate according to the need of
the medication. The NSAIDs are found to induce adverse side effects in older people after
administration such as hypertension, GI toxicity, renal malfunction, heart failure and adverse
CV events (Arnstein & Herr, 2017).
Effective Analgesics
Morphine along with acetaminophen, ibuprofen is found to have effective result as
Analgesics (Raffa et al., 20180. These drugs are found to have lesser side effects when
compared to other painkillers and drugs for older people. These drugs do have some side
effects such as vomiting, nausea and dizziness. Morphine is found to be the most effective
drugs among all as a painkiller for metastasis in spine and other bones in older people and is
found to have effective outcome (Rizkalla et al., 2018).

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References:
Arnstein, P., & Herr, K. A. (2017). Persistent pain management in older adults. Journal of
gerontological nursing, 43(7), 20-31.
Raffa, R. B., Pawasauskas, J., Pergolizzi, J. V., Lu, L., Chen, Y., Wu, S., ... & Devarakonda,
K. (2018). Pharmacokinetics of oral and intravenous paracetamol (acetaminophen)
when co-administered with intravenous morphine in healthy adult subjects. Clinical
drug investigation, 38(3), 259-268.
Reid, M. C., Eccleston, C., & Pillemer, K. (2015). Management of chronic pain in older
adults. bmj, 350, h532.
Rizkalla, N., Zane, N. R., Prodell, J. L., Elci, O. U., Maxwell, L. G., DiLiberto, M. A., &
Zuppa, A. F. (2018). Use of Intravenous Acetaminophen in Children for Analgesia
After Spinal Fusion Surgery: A Randomized Clinical Trial. The Journal of Pediatric
Pharmacology and Thera