Answer 1:
Pain stimulus can be divided into three subtypes, Nociceptive pain, Neuropathic pain and Psychogenic pain. The most common form of pain is nociceptive pain, which is seen in the case study provided. Ms. Sue seems to be suffering from Nociceptive pain which is caused due to external or internal injury. In cases of external injury the pain does not persist for long time Non Steroidal Anti-Inflammatory Drugs (NSAID) is prescribed to the patients, but if the condition is more severe, additional opioid prescription is also allowed. The pain mechanism consists of three neurons, which connects peripheral tissues like skin and muscles with the cerebral cortex. The neurons form a vast network to ensure as much tissues as possible is connected to the cortex (Davidson et al., 2012). The peripheral tissues are connected to the spine by peripheral neurons, which are further connected to the thalamus by Spinothalamic tract neurons. The thamalus is connected to the cortex by Thalamocortical neurons. The progression of nerve impulse within these three places occurs even less than a millisecond. Lower back pain can occur due to various problems, like muscle strain, ligament sprain, lumbar disc injuries et cetra. These conditions can result due to heavy object lifting, twisting of spine while lifting as well as sudden accidents of movement that would injure or stress the bones and muscles in the lower back portion (Sterud & Tynes, 2013). In the case study is it evident that the woman had public service which required her to do heavy machinery and equipment operation as a part of her job. Fire-fighters are known to lift or pull hose-pipes, perform rigorous training activities, and sometimes undergo service injury (Guidotti, 2013).
Answer 2:
Chronic Low back pain is of two types, Nociceptive and Neuropathic form. The most effective and widely accepted form of chronic Nociceptive the LBP treatment is administration of Non-Steroidal Anti-Inflammatory Drugs (NSAID) (Samraj & Kuritzky, 2012). The process of management of chronic pain is done as the following- introduction of NSAID like paracetamol, followed by additional administration of opioids, if the pain still persists, strong opioids like morphine is prescribed. NSAID is a type 2 schedule drugs, which has anti-inflammatory and anti-pyretic actions. These types of drugs are usually prescribed to patients with mild of moderate pain in the pain numerical analysis, like in the case study provided. In cases with gastrointestinal disorders, asthma allergy reduction and kidney damage is also prescribed NSAID (Jó?wiak-Bebenista & Nowak, 2014). The mechanism of action of NSAID drugs are inhibition of synthesis & release of Prostaglandins by prohibiting Cyclo-oxygenase enzymes (COX) (Samraj & Kuritzky, 2012). The isozymes of COX-1 and COX-2 have separate physiological action; painkilling function of NSAID is associated with inhibiting of COX-2, whereas other side effects can occur due to the prohibition of COX-1 and COX-2. NSAIDs that are available commercially, like acetaminophen and aspirin, seem to have potential side effects, affecting gastrointestinal and cardiac output. The therapeutic activity of all NSAIDs function by inhibiting the COX isozymes, researtchers are trying to find techniques to reduce the risk related with NSAIDs while not hampering their pain relief functionality (Brune & Patrignani, 2015).
References:
Brune, & Patrignani, P. (2015). New insights into the use of currently available non-steroidal anti-inflammatory drugs. Journal Of Pain Research, 105. https://dx.doi.org/10.2147/jpr.s75160
Davidson, S., Zhang, X., Khasabov, S. G., Moser, H. R., Honda, C. N., Simone, D. A., & Giesler Jr, G. J. (2012). Pruriceptive spinothalamic tract neurons: physiological properties and projection targets in the primate. Journal of neurophysiology, 108(6), 1711-1723. https://doi.org/10.1152/jn.00206.2012.
Guidotti, T. (2013). Critical Study of the Association Between Disease and Occupation as a Firefighter. Archives Of Environmental & Occupational Health, 68(1), 1-2. https://dx.doi.org/10.1080/19338244.2012.678195.
Jó?wiak-Bebenista, M., & Nowak, J. Z. (2014). Paracetamol: mechanism of action, applications and safety concern. Acta poloniae pharmaceutica, 71(1), 11-23. https://www.ptfarm.pl/pub/File/Acta_Poloniae/2014/1/011.pdf
Samraj, & Kuritzky, L. (2012). Nonsteroidal anti-inflammatory drugs in the treatment of low back pain. Journal Of Pain Research, 579. https://dx.doi.org/10.2147/jpr.s6775
Sterud, T., & Tynes, T. (2013). Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway. Occup Environ Med, 70(5), 296-302. https://dx.doi.org/10.1136/oemed-2012-101116.
