The lumbar spine is responsible for forming the caudal flexible portion of the axial structure that supports the upper extremities, the head and the internal organs over a bipedal stance. The sacrum is known to act as a foundation of the spine, and the lumbar spine is responsible for supporting heavy loads in relation to the cross-sectional area. The anterior gravitational movement is resisted through the maintenance of lordosis in a neutral position. The lumbar spine doesnot have a lateral support and has significant mobility in coronal and sagittal planes. The intervertebral disk has the inner nucleus pulposus and the outer annulus fibrosis (Clarke er al., 2011). Bony projections that originate from the lumbar vertebra, including the transverse processes and spinous processes, are responsible for maintaining ligamentous and muscular connections to the segments below and above them (Cox, 2012).
Repeated torsional and eccentric loading in combination with recurrent microtrauma leads to circumferential and radial tears in annular fibers. Certain tears lead to endplate separation, causing significant loss of nuclear nutrition and hydration. The nuclear material might migrate out of the containment due to coalescence of circumferential tears into radial tears. Under such condition, the material enters the epidural space, leading to irritation and nerve root compression. With decrease in disk height, the posterior articulations are forced to bear greater percentages of the weight distribution. Under such conditions the bone growth is known to compensate for the augmented stress for stabilizing the trijoint complex. Lower back pain is suffered under such physiological condition. The healing process is not adequate as there is poor supply of blood.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a reputed group of therapeutic agents that have similar mode of actions even though they have different pharmacodynamics and structural profiles. NSAIDs are the first line of drugs for management of low back pain among other acute or chronic conditions where the patient is suffering from inflammation and pain. The drugs have an analgesic action that is associated with the inhibitory action of the drug on the enzymes synthesising prostaglandins. The drugs act as inhibitor of peripheral pain as they work through a potential analgesic pathway. Multiple mediators at the periphery trigger nociception when there are chemical, physical or electrical stimuli. Nociceptors are sensitized by synergistic actions of prostaglandins with other mediators. Analgesic action of NSAIDs is due to the commotion of the process of synthesis of central prostaglandins and other modulators in the nociceptive pathway (Takahashi et al., 2017). There also exists proof for the inhibitory impact of the drug on prostaglandin expression in cerebrospinal fluid due to N-methyl-D-aspartate (NMDA) receptor activation. Further, NSAIDs also has been proven to have inhibitory effect on the lipoxygenase pathway due to the presence of algogenic metabolites whose production is increased. The drug might interfere with G-protein-mediated signal,forming the rationale for an analgesic mechanism where prostaglandin synthesis inhibition does not have any role (Machado et al., 2017).
In the present case, sue has been suffering from low back pain. More precisely the Numeric Pain Rating Scale assessment reveals that she suffers from moderate pain. The action is supposed to occur within 24 hours. The side effects might be diarrhea, nausea, vomiting (Enthoven et al., 2016).
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