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Response To Body Integrity Question: Discuss about the Challenge And Response To Body Integrity.     Answer: Physiology Of Low Back Pain Sue has lower back pain as consequence of the physical demands of Fire and Rescue Service. Nocireceptors are common cause of pain radiating in back from the place of tissue injury, via transmission of impulse from place of tissue injury. It is the physiologic response of the body. The neuron makes connections in both spinal cord and brain and alerts us of damaging stimuli (via transduction, conduction, and transmission) followed by spinal modulation, and relay the message to higher brain centres via electrical signals. These signals are interpreted as pain by brain (CNS) and leads to supraspinal responses. The pain may commonly arise from the herniated disc, which is the cause of the pain due to unwanted contact between the nerve and the disc (Craft et al., 2015, pp.137-153). Lifting heavy materials increases the stress on the disc. Back pain is developed when the disc is herniated and some of the inner fluid is leaked (Parker et al., 2015).  It is the wear and tear process of the disc may occur in lumbar spine resulting protrusion against spinal nerve root. This process is known as degenerative cascade (Bhalla et al., 2016). The other possible reason may be the lumbar spinal stenosis. It occurs due to enlargement of the facet joints of the segment. The condition causes compression of the spinal nerve roots and is due to degenerative conditions such as spondylolisthesis and osteoarthritis, where the pain radiates from the lower back to the legs (Tobert & Harris, 2018). Pharmacological Actions And Effects Of NSAIDS For Sue’s Condition NSAIDS are popularly used for the pain management. NSAIDS exhibit their pharmacological action by inhibiting the Cyclooxygenase (COX), which in turn inhibits the synthesis of the prostaglandin and other eicosanoid. COX1 play role of housekeeping and regulates normal cellular process (protects kidney and stomach platelet aggregation).  COX2 is responsible for the increased Prostanoid production during inflammation (via cytokines). They play a dominant role in the inflammation and cancer. It contributes to pain and swelling of inflammation.  Prostaglandins are consistently expressed in bones, kidney, brain and results in inflammation when expressed at other sites (Bryant & Knights, 2014, pp. 319 – 339). Consequently the homeostatic mechanism is disrupted with NSAIDS. In Sue, the NSAIDS will help lower the pain caused in lumbar spine. Arachdoinic acid is central to this pathway of NSAIDS that exhibits anti-inflammatory effect at the site of injury of pain (lower back pain in case of Sue). Inflammation results in vasodilatation extravasation of protein exudates and nociception. In this process prostaglandins are key players in this process and are thus inhibited during lower back pain (Enthoven et al., 2016).  Therefore NSAIDS lower pain and inflammation in lower back pain when administered to Sue. It is useful for reducing stiffness in Sue. NSAIDS are administered in dose dependent manner. Higher dose is effective for the   higher degree of swelling, stiffness and pain. The therapeutic and toxic effects vary in different drugs. The side effects may include kidney damage. Liver damage is found in patients with alcohol use, when administered with acetaminophen. It might be risk for Sue as takes alcohol and is recommended to take for short period of time (Schilling, 2016).   References Bhalla, A., Schoenfeld, A. J., George, J., & Bono, C. M. (2016). The Influence of Sub-Diagnosis on Radiographic and Clinical Outcomes after Lumbar Fusion for Degenerative Disc Disorders: a 15-Year Meta-Analysis. The Spine Journal, 16(10), S366. DOI: Bryant, Bronwen & Knights, Kathleen, (author.) (2015). Pharmacology for health professionals (Fourth edition). Chatswood, New South Wales Mosby. isbn=978-0-7295-8171-4  Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2015). Understanding pathophysiology-ANZ adaptation. Elsevier Health Sciences. ISBN : 9780729541602 Enthoven, W., Roelofs, P. D., Deyo, R. A., van Tulder, M. W., & Koes, B. W. (2016). Non?steroidal anti?inflammatory drugs for chronic low back pain. The Cochrane Library. DOI: 10.1002/14651858.CD012087 Parker, S. L., Mendenhall, S. K., Godil, S. S., Sivasubramanian, P., Cahill, K., Ziewacz, J., & McGirt, M. J. (2015). Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clinical Orthopaedics and Related Research®, 473(6), 1988-1999. DOI: Schilling, R. (2016). Pain Treatment. Pain. Retrieved from: Tobert, D. G., & Harris, M. B. (2018). Degenerative Lumbar Spinal Stenosis and Spondylolisthesis. In Principles of Orthopedic Practice for Primary Care Providers (pp. 47-59). Springer, Cham. DOI:

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