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Cuccurullo Book > Ch 11 - Pain Medicine: Pain Syndromes > Flashcards

Ch 11 - Pain Medicine: Pain Syndromes Flashcards

1
Q

Description of Nociceptive/Somatic pain

A

Deep somatic pain: dull/aching
Superficial somatic pain: sharp, pricking
Burning, localized, reproducible

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2
Q

Description of Visceral pain

A

Crampy and dull

Vague in location

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3
Q

Description of Neuropathic/Central pain

A

Burning, tingling, shooting, stabbing, electric-like

May be associated with numbness, tingling

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4
Q

What is the cause of nociceptive/somatic pain?

A

noxious perception from tissue damage mediated by the somatic nervous system

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5
Q

What is the cauase of visceral pain?

A

Organs mediated by ANS

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6
Q

What is the cause of neuropathic/central pain?

A

Lesion or dysfunction in CNS or PNS

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7
Q

What is myofascial pain?

A

Localized and referred soft-tissue pain that can exhibit sensory, motor, and autonomic symptoms arising from myofascial trigger point

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8
Q

What is a myofascial trigger point?

A

hyperirritable point within a taut band of skeletal muscle or fascia that is painful on compression

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9
Q

What is Complex regional pain syndrome (CRPS)?

A

neuropathic pain disorder affects one or more extremities and usually occurs following a physical injury

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10
Q

What are the types of CRPS?

A

CRPS I: without nerve damage

CRPS II: nerve damage

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11
Q

Medications used for CRPS

A

NSAIDs, antidepressants, anticonvulsants, opioids (limited data), topical dimethyl sulfoxide (DMSO), and oral N-acetylcysteine (NAC)

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12
Q

What procedure can be useful in CRPS?

A

Sympathetic nerve blocks

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13
Q

Describe CRPS pain

A

Continuing pain, allodynia, or hyperalgesia in which the pain is disproportionate to any known inciting event

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14
Q

What can be signs of CRPS?

A

edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain

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15
Q

What is Interstitial cystitis?

A

Chronic inflammatory condition of the bladder’s submucosal and muscular layers

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16
Q

What is a Hunner’s ulcer?

A

Patches of broken skin on the bladder wall

Present in 10% of interstitial cystitis

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17
Q

Describe K+ sensitivity test

A

Positive if patient experiences pain with urinating K+/water vs water from bladder alone

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18
Q

What is first line treatment for interstitial cystitis?

A

Patient education
Diet modification
Stress modification

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19
Q

What is second line treatment for interstitial cystitis?

A 
PT
Oral medications (amitriptyline, cimetidine, hydroxyzine, pentosan polysulfate)
Bladder instillations (DMSO, heparin, lidocaine)
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20
Q

What is third line treatment for interstitial cystitis?

A

Treatment of Hunner’s ulcers (laser, fulguration,
triamcinolone injection)
Hydrodistention (low pressure, short duration)

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21
Q

What is fourth line treatment for interstitial cystitis?

A

Neuromodulation (sacral or pudendal nerve)

22
Q

What is fifth line treatment for interstitial cystitis?

A

Cyclosporine A, Botulinum toxin

23
Q

What is sixth line treatment for interstitial cystitis?

A

Surgical intervention (urinary diversion, augmentation, cystectomy)

24
Q

What is Irritable bowel syndrome (IBS)?

A

Abd pain or discomfort for 6 mo & at least 3x/mo for the last 3 mo w/o other cause

25
Q

What are symptoms of Irritable bowel syndrome (IBS)?

A 
Chronic abdominal pain
Discomfort
Bloating
Urgency to move bowels
Tenesmus
Alteration of bowel habits 
Improvement of pain with bowel movement
26
Q

What comorbidities are associated with Irritable bowel syndrome (IBS)?

A

HA
Fibromyalgia
Depression
Chronic fatigue syndrome

27
Q

Tx of IBS

A

Diet modification
Psychotherapy
Probiotics
Oral medications (fiber supplements, laxatives) Antidiarrheals (loperamide)
Antispasmodics (hyoscine, cimetropium, pinaverium)
Antidepressants (TCAs, SSRIs), or Amitiza (lubiprostone)

28
Q

What do the sacral nerves provide sensory and motor innervation to?

A

Anorectal region and motor innervation to the external anal sphincter and levator ani muscles

29
Q

Which viscera are innervated by S1-4?

A

Bladder
Urethra
External genitalia

30
Q

What is a Presacral neurectomy used for?

A

Midline chronic dysmenorrhea that is unresponsive to medical management

31
Q

What is a Presacral neurectomy?

A

Total transection of the presacral nerves, superior hypogastric plexus, lying within the boundaries of the interiliac triangle

32
Q

What is a LUNA procedure?

A

Under laparoscopy, uterus is anteverted with a uterine manipulator and the uterosacral ligaments, which carry nerve fibers, are identified and transected close to their cervical attachment.

33
Q

What is Piriformis syndrome?

A

Compression or irritation of the sciatic nerve by the piriformis muscle, resulting in pain, numbness, and tingling in the buttocks that may radiate into the thigh and lower leg

34
Q

What kind of pain is present in 30% of HIV patients?

A

Peripheral neuropathic pain

35
Q

Which HIV medications can cause peripheral neuropathy?

A

didanosine and stavudine

36
Q

What can contribute to HA in HIV patients?

A

Cryptococcal meningitis

Zidovudine

37
Q

What can cause abdominal pain in HIV patients?

A

Mycobacterium avium complex [MAC] infection

38
Q

What is a common first symptom of MS?

A

Optic neuritis

Usually resolves in 7 to 10 days

39
Q

What is the most common pain syndrome in MS?

A

Neurogenic: dysesthesias, often occurs in legs

Lhermitte’s sign

40
Q

Describe pain in peripheral vascular disease

A 
Intermittent claudication: calf pain on exercise
Critical limb ischemia: pain at rest
Aching
Cramping
Burning in feet, calves or thighs
41
Q

What is chronic pain in sickle cell disease typically secondary to?

A

AVN (hips > shoulders > ankles)

42
Q

What can be seen on x-ray of the spine with chronic back pain in sickle cell disease?

A

Fish mouth appearance of spine

43
Q

What is Rheumatoid arthritis?

A

systemic disease characterized by inflammation of the membranes lining the joints and synovium

44
Q

What is the cause of pain in RA?

A

Synovitis
Usage related joint pain secondary to weakness
Secondary arthritis

45
Q

Describe symptoms of Ankylosing Spondylitis

A

Pain and stiffness in SI, low back and buttock that is gradual over weeks to months
Pain unilateral, bilateral or alternating
Worse in the mornings and at night

46
Q

What can improved the symptoms in Ankylosing Spondylitis (AS)?

A

Warm shower

Light exercise

47
Q

Describe the epidemiology of Fibromyalgia patients

A 
Female-to-male ratio of 3:1 
>50 years of age
Low educational level
Low socioeconomic status
Living in rural areas
48
Q

What is the mechanism of Fibromyalgia?

A

CNS sensitization that leads to “disordered afferent processing” and increased levels of excitatory neurotransmitters (glutamate, substance P) and/or low levels of inhibitory neurotransmitters (5HT, NE, GABA)

49
Q

What are the symptoms of Fibromyalgia?

A 
Multifocal pain
Fatigue
Insomnia
Cognitive or memory problems
Psychological distress
50
Q

How is Fibromyalgia diagnosed?

A

Tenderness at 11 or more of 18 specific tender point sites (pressure at 4 kg/cm2).

51
Q

What are pharmacologic treatments of Fibromyalgia?

A
  1. TCAs and cyclobenzaprine shown to be efficacious in RCTs
  2. Pregabalin (FDA approved in 2007)
  3. Duloxetine (FDA approved in 2008)
  4. Milnacipran (FDA approved in 2009)
52
Q

What are nonpharmacologic treatments of Fibromyalgia?

A
  1. Exercise
  2. Behavioral medicine
  3. Educational approaches

Cuccurullo Book (91 decks)

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