1.Explain the pathophysiology of John’s lower back pain and discuss briefly the effectiveness of NSAIDS for pain management in older people?
Based on the information the case study has given, the MRI report showed that John has metastatic lesions in his thoracic and lumbar vertebrae. According to Rose and Buchowski (2011), pain is the most common symptom in patients with metastatic spine problem which consist of approximately up to 90%. John’s lower back pain can either be constant and localised pain or radicular pain. Georgy (2008) mentioned that constant and localised pain is generally thought to be caused by periosteal stretch happening with tumour growth. The radicular pain on the other hand causes pain due to the tumour growth and it presses against the nerve root.
2. Following the MRI report, and the pain being persistent, which analgesics should be prescribed to Mr John?
Effect of opioid exposure on efficacy and tolerability sublingual morphineand subcutaneous morphine for severe cancer pain episodes. Secondary analysis from a double-blind double-dummy, randomised trial. Journal of Pain and Symptoms management