Seventy-nine-year-old Sue served in Northern Territory Fire and Rescue Service until her resignation 19 years ago. One of the reasons was her long-term back pain. She rarely drinks alcohol and does not smoke. She is taking an over-the-counter calcium supplement, Vitamin D and levothyroxine sodium. She has been feeling exhausted for the past month and has been suffering from stiffness and pain. She developed pain in the lower back and decided to seek help at the Emergency Department at Royal Darwin Hospital. When ED physician John noticed in his clinical examination, there was acute tenderness and central protrusions in Sue’s back, more explicitly L3 to L4 spinal segment positioned in the middle of the lumbar spine. When the clinical nurse assessed her pain intensity with Numeric Pain Rating Scale, she rated within the range of mild pain. She underwent MRI scanning and was prescribed a non-steroidal anti-inflammatory medication to be taken when she experiences pain.

Answer only TWO questions
1. Explain the physiology of low back pain.
2. What is the significance of acute tenderness over L3 and L4?
3. Discuss the pharmacological actions and effects of NSAIDS for Sue’s condition
4. Provide reasons for Sue’s lower than expected nociception.