B2 L23 Part 1 Referred, Radicular pain

Question 1

What is the physiological basis of referred pain?

Answer 1

Convergence of nociceptive pathways

Question 2

What is convergence of nociceptive pathyways?

Answer 2

Afferent fibers from the vertebral column synapse in the spinal cord with second-order neurons that also receive afferents from other nerves.

The brain is unable to determine whether the information it receives from the second-order neuron was initiated by the vertebral afferent or the other convergent fibers, so attributes both.

Question 3

In referred pain, convergence is typically _______. However, convergence may also occur between _______ spinal cord segments, resulting in _______ (more/less) disparate patterns of referred and local pain

Answer 3

segmental; consecutive; less

Question 4

Give an example of upper cervical pain being referred to the forehead.

Answer 4

afferents of the trigeminal nerve from the forehead afferents in the third cervical spine nerve

Question 5

The essential feature of spinal referred pain that distinguishes it from neurogenic and radicular pain is that it is ________ in nature.

Answer 5

nociceptive

Question 6

In referred pain, the pain is initiated by ______ of nerve endings of ______ fibers that innervate the vertebral column and its associated structures. Afferent fibers from the region of referred pain (e.g. the forehead), ____ (are/are not) stimulated by the causative lesion.

Answer 6

stimulation; afferent; are not

Question 7

Referred pain is often a _____ and _____ in quality; although its _____ region is recognizable and constant, margins are hard to define

Answer 7

deep; ache; central

Question 8

What are some patterns of visceral referral?

Answer 8

Visceral nociceptors transduce stretch/distention, chemical irritants or ischeamia.

Question 9

What is the physiological basis of radicular pain?

Answer 9

Nociception by the axons being stimulated along their course (peripheral terminals are not stimulated)

Question 10

What are 2 reasons why ectopic activation may occur in radicular pain?

Answer 10

1. mechanical deformation, inflammation or ischaemia of a dorsal root ganglion 2. mechanical stimulation of previously damaged nerve roots

Question 11

How does radicular pain differ from referred pain? Give 3 differences or characteristics?

Answer 11

1. The processes that cause radicular pain could affect a range of sensory afferents incl. muscle, joints and skin (as well as motor efferents), resulting in a sensation that is more than pure nociception. 2. Radicular pain is usually lancinating in quality and may be perceived along narrow bands reminiscent of but may not be identical to the bands of dermatomes 3. Radicular pain has a cutaneous quality

Question 12

What is cervical radicular pain defined as?

Answer 12

Pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots.

Question 13

In the absence of a gold standard, what are 4 possible factors that the diagnosis of cervical radicular pain is based on?

Answer 13

history clinical examination (potentially) complementary examination. Medical imaging (may show abnormalities, but those findings may not correlate with the patient’s pain)

Question 14

Conservative treatment for cervical radicular pain typically consists of ______ and _______.

Answer 14

medication; physical therapy no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction.

Question 15

When conservative treatment for cervical radicular pain fails, _______ intervention may be considered.

Answer 15

surgical

Question 16

What are 2 things that education emphasises in nerve-related neck and arm pain?

Answer 16

1. Nerves in the neck and arm had become overly sensitive to movement.
2. neural tissue techniques would move the nerves in a gentle and painfree manner, to reduce this sensitivity.

Question 17

What are some manual therapy techniques for nerve-related neck and arm pain?

Answer 17

contralateral cervical lateral glide and a shoulder girdle oscillation combined with active craniocervical flexion to elongate the posterior cervical spine

Question 18

What are some home nerve exercises for nerve-related neck and arm pain? Explain sliding and tensioning?

Answer 18

‘sliding’ lengthened the median nerve bed (elbow and wrist extension) counterbalanced by shortening with neck lateral flexion towards ‘tensioning’ lengthened the median nerve bed (elbow and wrist extension alone or combined with neck lateral flexion or rotation away).

Question 19

What are 2 processes that occur during neuroinflammation (entrapment neurpathies)? (eg. image is in the DRG after mild nerve compression (rat sciatic and DRG at L5))

Answer 19

1. A slight upregulation in numbers of macrophages
2. Activation of satellite glial cells.

Question 20

What occurs during mild peripheral nerve compression (This study is done with rats)?

Answer 20

Preferential small axon damage evidence in the Dorsal Root Ganglion

Question 21

The green marker for damaged (axotomised) neurones (in midl peripheral nerve compression) is preferentially found in neurones with _____ (large/small) diameter, most likely representing ______ (myelinated/unmyelinated) C-fibres or small _______ (myelinated/unmyelinated) A delta fibres

Answer 21

small; unmyelinated; myelinated

Question 22

In treatment for patients who have a buttock or leg pain that was described as all one pain, what are some general treatment aims?

Answer 22

Manual therapy helped with sensitivity Correction of technique