Question

Case Study B:

Ms. J. is a 30-year-old healthy single mother with two children. She has worked as a paramedic in her community for 6 years. She and her partner responded to a call involving a man who had been drinking heavily at a family party and who was partially conscious. When she and her partner attempted to transfer the 100-kg man to a stretcher, the man grabbed her neck, causing her severe pain. Ms. J.’s doctor diagnosed a spinal injury and completed papers for Ms. J. to be absent from work. He recommended rest and application of heat and cold to the neck. One week later, Ms. J. saw him again, reporting continuing pain. She was referred to a specialist who told her she had a herniated disk in the cervical area of her neck and would require ongoing care and rehabilitation. Ms. J. has been on disability leave for 6 months, during which she has continued to have severe neck, jaw, and back pain. She takes acetaminophen with codeine as required, and sees a physiotherapist and a registered massage therapist routinely in an attempt to control chronic pain. She is worried that her disability benefits will cease before she can return to work and has incurred debts during her leave. She also finds it difficult to care for her two children and keep the house clean.

1.What factors are significant in Ms. J.’s perception of pain? How might each be reduced?
2.Why has Ms. J.’s doctor not prescribed stronger narcotic medication?
3.Why does Ms. J. experience pain in her jaw and lower back when the injury was to her neck?
4.Where in the pain pathway do massage therapy and physiotherapy act to alleviate pain?
5.Ms. J. is concerned about maintaining her physical fitness and decides to attend exercise classes in her community pool. She finds this gives her more energy and reduces her pain. How does appropriate exercise affect pain perception? What precautions does Ms. J. need to observe when exercising?
6.Ms. J. hears about acupuncture as a help for back pain and does some research on the Internet before making an appointment for treatment. How could acupuncture act to block impulses for pain?
7.After 8 months, Ms. J. is cleared to return to work on a part-time basis, which she manages well. Why does she not return to full-time work immediately?
8.What can Ms. J. expect in the future as a result of this injury?

Answer 1

1.the factors significant for the MJ's percenption of pain are continous pain in her neck even after 1week rest.The continous complain of neck,jaw and back pain.It can be reduced by giving imporatnace to self care,reducing the daily activity work ,ice/heat therapy,taking over counter medications and not stressing too much on neck.

2.Analgesics such as acetominophen with codeine might can relieve most of the pain and other stronger narcotic medication might include steroids which are a bit overdose for Ms.J case right now.In her case the herniated disc is not too complicated otherwise the doctor might have suggested for any surgery.So it would be better to take medications prescribed by the doctor and would be helpful if she will do some physical activity to the neck.

3.Discs can bulge or herniate because of injury and improper lifting .the tough fibrous outerwall of the disc may weaken,and it may no longer be able to contain the gel like nuclues in the centre.This bulging or rupture through a tear in the disc wall are connected to the nerves of the facial muscles and spine.So in this case facing jaw pain and lower back pain is common.

4.The pain pathway may be interrupted with many points including the receptor sites,the peripheral nerve ,the spinal cord and the brain.The gate control theory recognizs the the role of synapses serving as open and close gate at points in the pain pathway in the centralnervous system So the physiotherapy and physical respond in case of such pains in the influence of natural endorphins and other stimuli.