Bob, a 67-year-old school janitor presented to his GP with lower back pain. He informed his GP that he has been generally active, walking and cycling regularly but his lower back pain has started to restrict these activities lately, in addition to affecting his daily job.
Upon questioning, Bob related that the lower pain has been there for the last 2 months and has gradually become more severe. On physical examination, there was acute tenderness over T12-L1. There were no other clinical signs. The GP was unsure of the origin of the lower back pain and prescribed a non-steroidal anti-inflammatory medication to be taken when he experienced pain. Bob saw his GP one week later and complained of worsening pain. The GP referred him to a rheumatologist.
The rheumatologist advised Bob to have magnetic resonance imaging (MRI) of the spine. Two weeks later MRI scan was done, and the report showed metastatic lesions in thoracic and lumbar vertebrae. Bob received a call from the clinic to come for an immediate consultation.
Please answer the following TWO questions:
1. What happens to pain threshold and behavioural response to pain in the older people and discuss briefly the effectiveness of NSAIDS for pain management in elderly.
(150 words approx.)
2. Following the MRI report, and the pain being persistent, which analgesics should be prescribed to Bob? Support your answer with evidence.
(250 words approx.)
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