Chronic Pain Flashcards
Describe acute pain
Last less than 3 months, associated with tissue damage and resultant nociceptive input
Describe pain physiology when there is an injury to tissues.
- release of neurotransmitters from primary neuron
- Release from immune cells of inflammatory mediators
- Combined with vasodilation response at nerve endings
- Over long period- increase in peripheral sensitisation
Describe how the body is signaled of pain?
- Peripheral activation of primary neuron
- Sensory signals transmitted from the periphery by afferent fibres enters the dorsal horn
- These synapses with intrinsic spinal horn neurons- 2nd order neurons
- Signals to the many areas of the brain
Define Chronic Pain
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
What are the types of chronic pain
Nociplastic
Neuropathic
Other
Describe nociplastic pain
- Changes in CNS
- Hyperalgesia + allodynia
- Pain echoes, fades slowly
- High levels of functional disability/ pain severity disproportionate
- No dermatomal pattern
- Widespread
Describe neuropathic pain
- Described as tingling or burning pain - common in feet or lower leg
- Dermatomal pattern (REVIEW) aggravated by movement
- Positive neurodynamic tests
Describe other chronic pain
- Inflammatory/immune disroders (RA, lupus, IBS)
- Post surgical interventions
What are some risk factors to recovery?
- Fear of pain and activity
- Sickness behaviour
- Low self-efficacy
- Low or negative moods, social withdrawal
- Poor treatment choice
- Claim/comp issues
- History of other claims, time off
- Problems at work, family etc
What are some patient reported outcome measures (PROMS)
- Orebro MSK pain screening questionnaire
- Short form Orebro
- STarT Back Screening Tool
- Whip Predict
What are some Electornic persistent pain outcomes?
- Brief pain inventory (BPI)
- DASS 21
- Pain self-efficacy Questionnaire (PSEQ)
- Pain catastrophising scale (PCS)
- Tampa scale kinesiophobia
- Fear avoidance beleifs questionnaire
What are risk factors/barriers to recovery?
- Belief pain and activity harmful
- Sickness behaviours
- Low self-efficacy
- Low or negative moods/ social withdrawal
- Treatment does not fit best practice
- Claims/comp issues
- History of other claims
- Problems at work/social
Describe Some Patient Reported outcome measures
- Orebro MSK pain screening
- Short form orebro
- STarT back screening
Whip predict
What are some Electronic persistent pain outcomes?
- BPI (brief pain inventory)
- DASS 21
- Pain self-efficacy questionnaire (PSEQ)
- Pain catastophising scale (PCS)
What other factors should be included as part of normal subjective assessment?
- Sleep
- Mood
- Work
- Pacing patterns
- Beliefs
- Goals
- Expectations
