5.13 - Neuropathic Pain Scheme Wrap Up Flashcards
What type of pain do victims of spinal cord injury usually have?
Mixed pain.
Nociceptive: somatic (MSK) and visceral.
Neuropathic.
If there was damage to the spine there may be vertebral column pain. What could occur acutely after an accident, what about later?
Mechanical instability of spine, due to injury to ligaments or fx of spine.
Later you may get spine deformities or OA.
Post spinal injury one could also have musculoskeletal pain (somatic), what could be some of the sources of this pain?
Bone, joint, muscle trauma.
Tendon inflammation.
Muscle spasm - visible and palpable.
Overuse muscle syndrome.
Instability of spine after injury.
What does secondary overuse pain refer too in spine injury pts? What type of spine injury pts are most susceptible? Where is this most common? Acute or gradual?
Pain in intact areas due to overuse of these areas.
Most common in paraplegics.
Gradual onset.
Shoulder pain: arthritis, tendinitis.
OA can occur.
Spine injury pts can also develop visceral pain with associated non-specific symptoms. What can be the etiology of this visceral pain?
Kidney stones.
Bowel dysfunction (constipation).
Appendicitis.
Gallbladder stones.
Gynecological.
What can be the cause of neuropathic pain in spinal cord injuries?
Peripheral nerve root entrapement.
Syringomyelia (intrinsic damage in spinal cord forms a cavity).
Burning, stabbing, shooting, paraxoysmal, allodynia, hyperesthesia, lancinating pain unilaterally is a sign of what?
Radiculopathy, nerve root entrapement.
What is transitional zone pain? What is it caused by?
At border of normal sensation and numb skin.
Bilateral.
Burning, aching, tingling, allodynia.
Pain within first few months of injury.
Caused by injury to gray matter of dorsal horn.
What is central neuropathic pain? (location, frequency, affected by?).
Pain below level of injury.
Constant.
Fluctuates with mood or activity.
Responds poorly to medication or other treatment.
How can you treat neuropathic pain?
Stubborn pain to treat.
Does not respond to conventional treatments.
Treat underlying mechanism if possible. Multiple modalities. Be aggressive.
PT, phychiatry, alternative meds (acupuncture), neurosurg, injections at TP.
What is a transcutaneous eletrical nerve stimulator, how can it be used?
Electrical stimulation on skin.
Gate pain theory.
Case Study Profile - Mixed pain
Male
Age 54
You are seeing a 54-year-old male in your office whose chief complaint is of increasingly severe chronic low back, chronic bilateral knee, and newer onset pain and numbness in both feet. His new symptoms have been present for 6 months and are not associated with any particular event or trauma.
His past medical history is notable for Type 2 Diabetes Mellitus known for six years. He has experienced non-disabling episodes of low back pain since his mid-30s. An MRI examination of his lumbar spine done 4 years ago demonstrated multilevel degenerative joint changes and disc desiccation but no disc herniation or nerve root impingement. It was ordered by an orthopedist who subsequently recommended therapeutic exercise as a treatment. He notes as well that recently his balance is “off” and that he has burning in his feet.
What type of pain is this? What are the give aways for recognizing this?
The above historically represents an instance of mixed pain. He has a known history of nociceptive somatic chronic pain conditions; chronic low back pain from spinal degenerative changes and osteoarthritis of the knees and recently has developed a neuropathic peripheral nerve pain condition; painful diabetic neuropathy.
Burning = neuropathic pain.
Knee + back = nociceptive.
What is diabetic peripheral neuropathy (ex)? How can you treat it?
Loss of small nerve fibers (b,c) due to diabetes leads to pain in periphery.
Paresthesias and dysesthesias of feet and hands. Lancinating pain. Deep aching and muscle cramping.
Refer to podiatrist, glucose management, follow-up care, rational and realistic goals.
Post-herpetic neuralgia, what is this? How would you treat it?
Post shingles etc. development of nerve pain.
Treat with pharm, injections, neurostimulatory, neurosurg, psych, pt.
