Care And Management Of Spinal Cord Injuries
Question:
Answer:
Explain the physiology of low back pain.
The lumbar spine is a structure of bones, joints, ligaments and nerves that works together for providing flexibility to the lower back. This spinal disc actually acts as shock absorbers between the vertebrae supporting the upper portion of the body (Hughes et al., 2012). Central disc protrusion is due to the natural deterioration of the lumbar spine over time. Central disc protrusion may be caused due to poor lifting techniques (Bedbrook, 2013). The disc in the spine is squeezed. If the pressure of the vertebrae and the disc continues then the disc may be forced to flatten or bend forward for without impacting each other. It is evident that there had been a central protrusion in the L3 and the L4 spinal segment of Sue. Disc protrusion is also known as slipped disc. This occurs, when one of the discs decays and the inner gel like matrix to get accumulated in a specific location to form a bulge or protrusion (Bedbrook, 2013). The bulging disc expands in the center of the spinal canal where the nerve roots and the spinal cord are located. If the protruded disc starts pressurizing any nearby nerve then radiating low back pain might occur. Lumbar disc protrusion may lead to herniated disc (Hughes et al., 2012). A pinched nerve in the lumbar region may lose its capability to carry the accurate neurosignals and the wayward signals can cause various sensations in the body (Issack et al., 2012). For example a compressed nerve can falsely signal pain. The most common type of nerve that is compressed is the sciatic nerve, which is the longest nerve in the body. It extends from the base of the spinal cord throughout the body. When the nerve is pinched in the beginning the pain is localized but will eventually have radiating effect (Bedbrook, 2013).
Discuss the pharmacological actions and effects of NSAIDS for Sue’s condition
There are a number of medications for the sciatica caused due to protruding discs. Most of the discs are painkillers. Muscle relaxants and NSAIDs can also be taken. In order to treat Sue’s condition, the NSAIDs like Ibuprofen, diclofenac and naproxen can be taken (Pinto et al., 2012). Care should be taken about the dosage as the NSAIDs can cause bleeding as it prevents blood clotting. Prolonged use of the NSAIDs can cause stomach ulcers and may also attribute to nephronal damage (Pinto et al., 2012).
Acetaminophen which is a paracetamol can also be given if inflammatory effect is seen in Sue. If Sue is having strong pain, opoids can be given such as morphine or tramadol (Deyo et al., 2015). Muscle relaxants can be given such as tetrazepam (Ammendolia et al., 2012). But they can give rise to dependancy if taken for more than two week. Another approach that can be taken to give relief to Sue is the Injection therapy; where the corticosteroids are directly injected in to the surrounding area of the affected nerve root. It can be done in two ways. In one case the medicine is directly injected in to the location of the nerve root. The process is known as the lumbar spinal nerve analgesia (LSPA) (Pinto et al., 2012). In another method the medicine can be injected in to the epidural space, which surrounds the spinal fluid and spinal cord in the spinal canal. In lumbar epidural anesthesia the spine is monitored by a computer tomography for making sure that the injection is administered at the right spot (Bedbrook, 2013).
References
Ammendolia, C., Stuber, K., de Bruin, L. K., Furlan, A. D., Kennedy, C. A., Rampersaud, Y. R., … & Pennick, V. (2012). Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review. Spine, 37(10), E609-E616.
Bedbrook, G. M. (2013). The care and management of spinal cord injuries. Springer Science & Business Media.
Deyo, R. A., Von Korff, M., & Duhrkoop, D. (2015). Opioids for low back pain. Bmj, 350, g6380.
Hughes, S. P. F., Freemont, A. J., Hukins, D. W. L., McGregor, A. H., & Roberts, S. (2012). The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain. J Bone Joint Surg Br, 94(10), 1298-1304.
Issack, P. S., Cunningham, M. E., Pumberger, M., Hughes, A. P., & Cammisa Jr, F. P. (2012). Degenerative lumbar spinal stenosis: evaluation and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 20(8), 527-535.
Pinto, R. Z., Maher, C. G., Ferreira, M. L., Ferreira, P. H., Hancock, M., Oliveira, V. C., … & Koes, B. (2012). Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. Bmj, 344, e497.
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