Case Study Analysis: Body Integrity, Spinal Cord Injury, and Treatment

This case study analyzes a patient, Sue, suffering from a spinal cord injury in the lumbar region (L3 and L4), likely due to lumbar disc herniation caused by years of physical labor. The assignment explores the symptoms, including acute tenderness, and the underlying causes of the injury. It then delves into the treatment approach, specifically the use of non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. The analysis explains the mechanism of action of NSAIDs, focusing on their ability to inhibit cyclo-oxygenase (COX) enzymes and thereby reduce the synthesis of prostaglandins and thromboxanes, which contribute to pain and inflammation. The document references relevant literature to support the analysis of the patient's condition and treatment plan.

Running head: BODY INTEGRITY
Question and Answers for a Case Study
Name of the Student
Name of the University
Author Note

1BODY INTEGRITY
Answer 1
All forms of damage to the spinal cord that result in a temporary or permanent change in
its function and translate into loss of muscular function, autonomic function or sensation at, or
below the parts of lesion are called spinal cord injuries. Depending on the severity of damage
and location of injury, the symptoms vary from paralysis to pain, numbness, and incontinence
(Bryce et al., 2012). In this case scenario, the patient Sue appears to suffer from spinal cord
injury in the lumbar region, specifically L3 and L4. The lumbar spine is located at the lower back
below the thoracic and cervical region and this made up of 5 vertebrae, L1-L5. The nerves and
spinal cord tissues present in lumbar vertebrae are specifically responsible for controlling
communication between the legs and the brain, damage to which subsequently affects the
growing and hip area. Acute tenderness in L3 and L4 arises due to lumbar disc protrusion
(Pouriesa, Fouladi & Mesbahi, 2013). Disc protrusion has probably resulted from compression of
the vertebrae present around the discs that made the latter in losing shape overtime and flattening
and expanding outwards. The work that she has been involved in over the years has resulted in
strength due to bending heavy lifting or repetitive and arduous use that has become painful.
These have resulted in injuries in the herniated disc as a part of general wear and tear of the
spinal cord, which in turn leads to pain discomfort and tenderness to touch (Chiu et al., 2015).
Thus, the symptoms of acute tenderness are indicative of lumbar disc herniation in the patient.
Answer 2
Non-steroidal anti-inflammatory drugs referred to the class of chemical compounds that
are used for decreasing fever, reducing blood clots and inflammation, and lowering pain severity.
NSAIDs are considered the major types of pain relievers and commonly include ibuprofen,

2BODY INTEGRITY
naproxen, and aspirin. The major reason for administering these drugs for treating the lumbar
pain condition is based on its mechanism of action and pharmacological properties. All of the
non-steroidal anti-inflammatory drugs have been found to share one common mechanism related
to inhibition of cyclo-oxygenase (COX) enzymes (Vane, Botting & Botting, 2012). This directly
results in a decrease in synthesis of a wide range of thromboxanes and prostaglandins, that might
have resulted in acute tenderness in the patient. Most of these drugs act as non-selective
inhibitors of the enzyme and inhibit both COX-1 and COX-2 isoenzymes, in a competitive
reversible manner. The COX enzyme is responsible for catalyzing thromboxane and
prostagloandin formation from arachidonic acid, derived from the phospholipid bilayer. These
prostaglandins have been found to play a major role as messenger molecules during pain and
inflammation (Altman et al., 2015). Sue reported stiffness and pain in her lower back due to
protrusions in L3 and L4. The NSAIDs have been prescribed for her due to their interaction with
endocannabinoid system that is utilised as substrates by the COX enzyme. In addition to
inhibition of prostaglandin synthesis, COX-2 activity inhibition is also responsible for NSAID-
mediated analgesia. Moreover, these drugs are also found to inhibit lipooxygenase pathway that
results in formation of algogenic metabolites, which in turn will reduce the pain severity in the
lumbar verterbra in the patient. NSAIDs also interfere with the G-protein mediated signal
transduction, which forms the foundation of its analgesic mechanism (Wehling, 2014). This wide
therapeutic variability and pharmacology of the non-steroidal drugs have been taken into account
before prescribing them for treating the low back pain in the patient.

3BODY INTEGRITY
References
Altman, R., Bosch, B., Brune, K., Patrignani, P., & Young, C. (2015). Advances in NSAID
development: evolution of diclofenac products using pharmaceutical
technology. Drugs, 75(8), 859-877.
Bryce, T. N., Biering-Sørensen, F., Finnerup, N. B., Cardenas, D. D., Defrin, R., Lundeberg,
T., ... & Treede, R. D. (2012). International spinal cord injury pain classification: part I.
Background and description. Spinal Cord, 50(6), 413.
Chiu, C. C., Chuang, T. Y., Chang, K. H., Wu, C. H., Lin, P. W., & Hsu, W. Y. (2015). The
probability of spontaneous regression of lumbar herniated disc: a systematic
review. Clinical rehabilitation, 29(2), 184-195.
Pouriesa, M., Fouladi, R. F., & Mesbahi, S. (2013). Disproportion of end plates and the lumbar
intervertebral disc herniation. The Spine Journal, 13(4), 402-407.
Vane, J. R., Botting, J. H., & Botting, R. M. (Eds.). (2012). Improved non-steroid anti-
inflammatory drugs: COX-2 enzyme inhibitors. Springer Science & Business Media, 103-
120.
Wehling, M. (2014). Non-steroidal anti-inflammatory drug use in chronic pain conditions with
special emphasis on the elderly and patients with relevant comorbidities: management
and mitigation of risks and adverse effects. European journal of clinical
pharmacology, 70(10), 1159-1172.