1)Pain is the body’s response to an incident that can potentially cause tissue damage(Craft And Gordon, 2014) older adults feel pain at a higher rate, chronic pain is also a lot more common (Craft And Gordon, 2014) The Pathophysiology of David’s pain can be explained as the Proteins, molecules and receptors are located in the neurons, these neurons send signals from the peripheral tissues to the to the spinal cord where the neuron will then release a chemical between the two neurons known as a transmitter which then sends messages to the cerebral cortex to respond to the potential of tissue damage and to respond to pain (Babos, Grady, Winsnoff & Mcgee 2013).
The type of pain David is experiencing can be associated as psychogenic at the time of presenting to the GP there is no obvious sign of an underlying issue and the pain being experienced is affecting his daily activities (Bryant and Knights 2015, p.
2a) Non-steroidal anti-inflammatory medication (NSAIDS) are found to be effective for the use of mild to moderate pain(Cohen, 2013) NSAIDS have been known to have an analgesic and anti-inflammatory effect on the body however use of this medication can have many side effects on the body of an older adult (Bryant and Knights 2015, p. 308-337). Not using NSAIDS correctly can cause gastrointestinal bleeding and the potential for gastric ulcers to perforate. When prescribing to the older adult we need to be informed of any past history including any gastrointestinal bleeding, if they are currently taking over the counter NSAIDS, if they are taking any Antithrombotic medication or if they are currently undergoing corticosteroid therapy as these all can be potential risk factors (Fowler, Durham, Planton & Edlund 2014), taking multiple NSAIDS could lead to toxicity, NSAIDS can be used in cold and allergy medications which is why a full history of medications is needed to prevent toxicity (Fowler, Durham, Planton & Edlund 2014).
2b) Using the WHO analgesic ladder I would move on from the first step of NSAIDS onto a stronger medication on the ladder two scale, however step two in most cases is missed(Forbes 2011). Most patients don’t want to go straight onto a strong opioids such as morphine to treat their pain, codeine is used once NSAIDS are no longer working for pain, the older adult may be prescribed codeine over morphine due to having a decrease in renal function(Forbes 2011). However, morphine from ladder three would be best prescribed providing David’s renal function is fine, Morphine is a strong analgesic and can be used for moderate to severe pain which can be from the result of recent trauma, surgery and cancer. The standard dose for morphine orally is 30mg.(Bryant and Knights 2015, p. 308-337)
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