Chapter 8 Workbook Questions

Question 1

What does “chronic pain as a disease” mean?

Answer 1

Chronic pain as a disease means that the neurons signalling pain are pathologically active. Despite the absence of continuing tissue damage and lack of noxious stimulation, the brain perceives pain.

Question 2

Explain the analogy between a malfunctioning burglar alarm and pathological pain.

Answer 2

A malfunctioning burglar alarm signals a burglary when there is no burglary occurring. Pathological pain signals tissue injury in tissues that are not injured.

Question 3

List the three categories of pathologic pain.

Answer 3

The three categories of pathologic pain are neuropathic, pain matrix dysfunction, and pain syndromes.

Question 4

What causes the pain in post-herpetic neuralgia, diabetic neuropathy, and Guillain-Barré syndrome?

Answer 4

The pain in post-herpetic neuralgia, diabetic neuropathy, and Guillain-Barré syndrome is caused by the central nervous system response to small fiber deafferentation.

Question 5

What causes the pain in fibromyalgia?

Answer 5

The pain in fibromyalgia is caused by pain matrix dysfunction. Pain inhibiting regions in the cerebral cortex have less gray matter and are significantly less active than normal, and pain signals are biologically amplified.

Question 6

What is the primary precipitating factor in the development of complex regional pain syndrome (CRPS)?

Answer 6

Disuse or nonuse is the primary precipitating factor for CRPS.

Question 7

Four months of lower back pain with shooting, burning pain radiating down the back of both lower limbs and decreased endurance of abdominal and low back muscles

What type of pain is this classified as?

Answer 7

Chronic pain syndrome

Question 8

Pain caused by a tumor pressing on nociceptors in the spinal cord meninges

What type of pain is this classified as?

Answer 8

Nociceptive chronic pain

Question 9

Phantom limb pain

What type of pain is this classified as?

Answer 9

Neuropathic chronic pain

Question 10

Gallbladder pain perceived as originating in the right subscapular region

What type of pain is this classified as?

Answer 10

Referred pain

Question 11

Fibromyalgia

What type of pain is this classified as?

Answer 11

Pain matrix dysfunction

Question 12

Which of the disorders listed below is/are psychogenic (caused by abnormal psychological factors):
	A. Phantom limb pain
	B. Pain in diabetic neuropathy
	C. Fibromyalgia
	D. Complex regional pain syndrome
	E. None of the above

Answer 12

E: Phantom limb pain and the pain in diabetic neuropathy are caused by the central nervous system response to deafferentation. Fibromyalgia is caused by pain matrix dysfunction. Complex regional pain syndrome is caused by genetic abnormality, trauma, and/or disuse of a limb. None of the disorders is caused by psychological abnormalities.

Question 13

Which of the following characterize the late stage of complex regional pain syndrome?
A. Trauma
B. Red skin, excessive sweating, edema, skin atrophy
C. Lack of any sympathetic activity
D. Muscle atrophy, osteoporosis, arthritic changes
E. Excessive acetylcholine release by postganglionic neurons

Answer 13

D: Early signs of CRPS include red or pale skin color, excessive sweating, edema, and skin atrophy. Later, the skin becomes dry and cold and the joints become stiff and swollen. If the condition progresses to its late stage, irreversible muscle atrophy, osteoporosis, and arthritic changes occur.

Question 14

Tinel’s sign is associated with which of the following?
A. Avulsion of dorsal roots as a result of trauma
B. Maladaptive structural reorganization with phantom pain
C. Neuropathic syndrome associated with fibromyalgia
D. Ectopic foci associated with peripheral neuropathy
E. All of the above

Answer 14

D: Tinel’s sign is pain or tingling elicited by tapping on an injured nerve. Tinel’s sign can only be elicited in the periphery, where neurons are not protected by the skull or vertebrae.

Question 15

Migraine symptoms are thought to be related to amplification of proprioceptive signals in which pathway?
A. Cranial nerve (CN) VII relay to spinal nucleus of thalamus
B. Trigeminolimbic pathway
C. Trigeminothalamocortical pathway
D. Fasciculus cuneatus relay to medial lemniscus
E. None of the above

Answer 15

C: In migraine, function of the facial nerve (Cranial nerve VII), spinothalamic, and fasciculus cuneatus are normal. Activity in the trigeminothalamocortical pathway is amplified.

Question 16

Which of the following contribute to chronic low back pain syndrome?
	A. Muscle guarding
	B. Abnormal movement
	C. Disuse syndrome
	D. A and B
	E. A, B, and C

Answer 16

E: Muscle guarding, abnormal movement, and disuse syndrome all contribute to chronic low back pain syndrome.

Question 17

Explain the difference in etiology between nociceptive chronic pain and neuropathic chronic pain

Answer 17

Nociceptive chronic pain is due to continued stimulation of nociceptive receptors. Neuropathic chronic pain is due to abnormal activity within the nervous system.

Question 18

What self-administered questionnaire can be used to determine whether a patients pain is neuropathic?

Answer 18

The Leeds Assessment of Neuropathic Symptoms and Sign (S-LANSS) is a questionnaire for determining whether pain is neuropathic or not.

Question 19

What are ectopic foci?

Answer 19

Ectopic foci are sites along an injured nerve that are abnormally sensitive to mechanical stimulation.

Question 20

what is central sensitization?

Answer 20

Central sensitization is a condition of abnormal, excessive excitability of central nociceptive neurons, produced by depolarization of NMDA receptors and by increased intracellular Ca2+.

Question 21

what happens when novel synapses form between afferents and central nociceptive neurons?

Answer 21

When novel synapses form between Aβ afferents and central nociceptive neurons, activity in the Aβ fibers produces signals that are perceived as painful.

Question 22

list two examples of painful mononeuropathies

Answer 22

Two painful mononeuropathies are median nerve entrapment in carpal tunnel syndrome and ulnar nerve compression at the elbow.

Question 23

what is phantom limb pain? what causes phantom limb pain? how can phantom limb pain be treated?

Answer 23

Phantom pain is pain that seems to originate from a missing limb. Phantom pain is caused by overactive neurons in the central pain pathways and maladaptive structural reorganization in the spinal cord, thalamus, and cerebral cortex. One effective treatment for phantom limb pain is movement therapy, including the use of a mirror to create the illusion that the phantom body part is visible and moving comfortably.

Question 24

what common pathology causes pain in diabetic neuropathy, Guillian-Barre Syndrome, and postherpetic neuralgia?

Answer 24

The common pathology causing pain in diabetic neuropathy, Guillian-Barré, and post-herpetic neuralgia is small fiber neuropathy. The deafferentation elicits sensitization in the central nervous system.

Question 25

What is the cmmon pathology in fibromyalgia, episodic tension-type headache, migraine, and chronic whiplash associated disorder?

Answer 25

The common pathology in fibromyalgia, episodic tension-type headache, migraine, and chronic whiplash-associated disorder is pain matrix dysfunction. In all four of these disorders, there is no peripheral nociceptor stimulation.

Question 26

Is fibromyalgia a psychological disorder? Describe the evidence for or against fibromyalgia as a psychological disorder

Answer 26

Fibromyalgia is not a psychological disorder. The majority of people with fibromyalgia are psychologically normal and are not depressed.

Question 27

What medications are ineffective for treating fibromyalgia?

Answer 27

Ineffective fibromyalgia medications include opioids, anti-anxiety drugs, NSAIDs (nonsteroidal anti-inflammatory drugs), and muscle relaxants.

Question 28

What criteria are used to classify a headache as a migraine?

Answer 28

To be classified as a migraine, a headache must meet at least two of the following criteria: unilateral location, pulsating quality, severity that interferes with daily activities, and aggravation by routine physical activity.

Question 29

What are the three events in migraine without aura?

Answer 29

The three events in migraine without aura are:

a. Migraine trigger (bright light, loud noise, prostaglandins, emotional stress, hormonal changes, specific foods or drinks, or meteorologic changes)
b. Excitation of hyperexcitable brainstem neurons
c. Activation of trigeminal afferents that synapse with trigeminal lemniscus neurons Trigeminal lemniscus and thalamocortical neurons become sensitized during a migraine, due to pain matrix malfunction.

Question 30

What is the pathology in complex regional pain syndrome

Answer 30

The pathology in Complex Regional Pain Syndrome includes increased levels of inflammatory neurochemicals in the periphery, partial denervation of skin, impairment of sympathetic regulation of blood flow and sweating, sensitization, and cortical reorganization.

Question 31

What intervention significantly reduces the incidence of complex regional pain syndrome post stroke?

Answer 31

Daily physical therapy and instruction to all hospital staff and family members on methods to avoid trauma to the paretic upper limb significantly reduces the incidence of Complex Regional Pain Syndrome post-stroke.