Bob, a 67-year-old school janitor presented to his GP with lower back pain. He informed his GP that...

Question

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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Bandita · Accepted Answer

Running Head: PAIN MANAGEMENT IN OLDER PEOPLE				1
NUR231 NURSING										6
NUR231 NURSING
Table of Contents
1.	3
Pain Threshold in Elderly People	3
Behavioural Response to Pain in Elderly People	3
Effectiveness of NSAIDS for pain management in Elderly	3
2.	4
Suggestions for Bob	4
Analgesics to Bob	4
References	6
1. 
Pain Threshold in Elderly People 
The older population is the rapidly growing section of the population worldwide. As elderly people grow with their age, the occurrence and ubiquity of pain also increases in frequency (Cheatham, Kolber & Cain, 2017). Generally, the pain in older people are either under reported or untreated as people think that pain is a very usual and typical process of aging.
Older people generally encounter pain, which is associated with chronic disorders, arthritis, cancer, joint and bone disorders. Older people encounter a usual exhibition of diseases, hence the sensitivity, perception as well as the tolerance to pain differs in elderly people. The pain threshold in elderly people is usually an inflated one. 
Behavioural Response to Pain in Elderly People 
Generally, older people ignore the pain caused by different reasons because they think that pain and aging goes hand in hand. They believe that it is a usual process and hence the incidence of pain in older people remains under reported in huge numbers. In some cases, older people show characteristic responses to pain, such as complaints about stiffness in muscles, or certain body parts, less movement, grimacing, restlessness, crying, reinforcement, rubbing, agitation as well as moaning (Langaas, Hurley, Dyrkorn & Spigset, 2019).

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...

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