Physiology of LBP for Sensory System- myassignmenthelp.com

Question: Discuss about thePhysiology of LBP for Sensory System. Answer: Low back pain (LBP) is one of the most common musculo-skeletal conditions that affect 84% of adult (Balague, 2012). In chronic LBP, the pain in the low back (lumbar) lasts for 3 months as Sue (Mostagi, 2015). Nociceptors are the specialized peripheral-sensorial form of neurons, which mediates pain sensation and provoke Sue to the potential stimuli (compression in lumbar-segment) in her skin. This occurs by transduction of the damaging- stimuli into the form of electrical signals, which were then transmitted (relayed) up to the higher centers of brain (Douglas, 2012). Nociceptors are the receptors that consist of pseudo-form unipolar-primary somato-sensory neurons having their neuronal bodies that are located in the DRG (dorsal-root ganglion) (Allegri, 2016). These are bifurcated axons; peripheral-nerve branch innervates skin (causes acute tenderness in Sue) while the central-nerve branch synapses with 2nd-order neurons that are located in the spinal cordsdorsal horn which transmits pain to the mesencephalon thalamus, then to somato-sensory anterior-form cingulated-cortex so as to enable discrimination between sensorial and affective-cognitive pain features respectively (Dubin, 2010). As the irritating stimulus of chronic stress persists in Sue, the peripheral as well as central sensitization occurs that converts acute to chronic pain with central protrusions. This central sensitization increases the excitability of CNS neurons that transforms normal inputs into abnormal responses causing acute tenderness in Sue (Allegri, 2016, Nijs, 2014). Minor alterations in posture, chronic stress with rich innervations of A-delta nerve-fibers in the bones, ligaments, vertebral- discs, and vertebral- bones result in chronification of LBP in Sue (Allegri, 2016). Pharmacological actions of NSAIDS NSAIDs are commonly used to treat pain in musculoskeletal problems (Lewis, 2013). Sues history suggests that she has long-term LBP along with stiffness, acute-tenderness and protrusions in lower-back (L3- L4). NSAIDs are used as the front-line agents for pain relief because of their rapid action with increased drug tolerance which is needed in Sues condition (Yacobi, 2013). NSAIDS exert its therapeutic-actions both locally at peripheral-inflammatory areas as well as centrally by inhibiting the synthesis and release of prostaglandins; although there is an effect on leukotriene production. The principal mode of action of NSAIDs is at the molecular level comprising of the inhibition of cyclooxygenase (COX) which is an enzyme that takes part in the arachidonic-acid cascade that synthesizes inflammatory- mediators of the prostaglandins. COX has 2 iso-forms as COX-1 and COX-2 in which COX-2 is better in its actions than COX-1 (Fig: 1) (Kuritzky, 2012).In Sue, the therapeutic-effects of NSAIDs occurs because of the therapeutic inhibition of COX-2 (Yacobi, 2013). COX-2 is the principle pathway along which the conversion of arachidonic- acid into inflammatory prostaglandins takes place in Sue (that produces pain). Therefore, interrupting this pathway; an action that is common in all NSAIDs (aspirin) is the basis for relief of pain in Sue (Kuritzky, 2012).COX-2 is commonly accepted as an inducible enzyme, i.e., COX-2 is inactive when the stimuli (as inflammation) are absent. Hence, NSAIDS are used at a low dose and at short- time for pain relief in Sue with chronic LBP. Reference Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C.,Fanelli, G. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4926733/#ref-1 Balague, F., Mannion, A.F., Pellise, F. (2012). Non-specific low back pain. Lancet, (9814), 48291. doi. 10.1016/S0140-6736(11)60610-7 Douglas, C. (2012). Potter and Perrys Fundamentals of Nursing- Australian version. (4th edition). Elsevier: St. Louis, Missouri Dubin, A.E. (2010). Patapoutian A: Nociceptors: the sensors of the pain pathway. J Clin Invest, 120(11), 376072. doi. 10.1172/JCI42843 Kuritzky, L., Samraj, G. P. (2012). Nonsteroidal anti-inflammatory drugs in the treatment of low back pain. J Pain Res, 5. 579590.doi:10.2147/JPR.S6775 Lewis, S.M., Heitkemper, M. M., Dirksen, S.R. (2013). Medical Surgical Nursing: Assessment and Management of Clinical Problems. (9th ed.). Missouri: Mosby. Mostagi, F.Q., Dias, J.M., Pereira, L.M. (2015). Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects.J Bodyw Mov Ther, 19(4), 63645. doi. 10.1016/j.jbmt.2014.11.009 Nijs, J., Malfliet, A., Ickmans, K. (2014). Treatment of central sensitization in patients with 'unexplained' chronic pain: an update. Expert Opin Pharmacother, 15(12), 167183. doi. 10.1517/14656566.2014.925446 Yacobi, A. (2013). Integration of Pharmacokinetics, Pharmacodynamics, and ..effects of NSAIDS, 193, Retrieved from https://books.google.co.in/books?isbn =147571520X