040915 back pain Flashcards
straight leg raise tests for
sciatica–would have shooting pain down
nociceptive pain
soft tissue damage/inflam
ex: infection, rash, RA, gout, tumor in soft tissue
do NSAIDs work for nociceptive pain?
yes, they reduce inflam pain. opioids also effective
quality of neuropathic pain
burning, electrical quality
allodynia to light touch common
resistant to NSAIDs and opioids
pain is conveyed through what system?
anterolateral system
nociceptors release what two things in the spinal cord?
glutamate
substance P
spinothalamic tract mediates what aspects of pain
mediates discriminative aspects of pain and temperature sense (location, intensity, duration)
axons from spinothalamic tract terminate where
ventral posterior lateral (VPL) nucleus of thalamus
central lateral nucleus of thalamus
3rd order axons from VPL project to?
somatosensory cortex
3rd order axons from central lateral nucleus project to?
many areas of cortex, limbic cortex (cingulate gyrus, hippocampus, amygdala)
spinoreticular tract
2nd order axons terminate in reticular formation in medulla or pons
mediates changes in level of attention to painful stimuli
spinomesencephalic tract
2nd order neurons terminate in midbrain in periaqueductal gray. neurons in PAG send axons back down that inhibit pain signals
exogenous opioids act where on pain pathway
descending pathways that inhibit pain
locus ceruleus (NE) raphe nuclei (serotonin)
presence of abnormal MRI findings doesn’t correlate well with clinical symptoms: true or false
true
best tx for acute back pain
NSAIDs
