Chronic Pain Flashcards
How is juvenile fibromyalgia characterized?
persistent widespread msk pain, fatigue, and non restorative sleep
What somatic symptoms often accompany juvenile fibromyalgia?
IBS, headaches, dysautonomia
What medications can be helpful for juvenile fibromyalgia?
low-dose tramadol, amitriptyline, and stimulants
How long do symptoms need to be present for a diagnosis of fibromyalgia?
3 months
Which type of CRPS is associated with peripheral nerve injury?
II
What is the cornerstone of effective treatment for CRPS?
Gradual progression in functional restoration from sensation activation to ROM to weight loading
What are two types of therapy that can be helpful for CRPS?
desensitization, mirror
What is the most common type of primary pediatric headache?
tension
What are two key features of pediatric abdominal migraines?
intermittent nature, strong family history of migraine headaches
What are three medications that can be helpful for functional abdominal pain?
SSRIs, TCAs, Cyproheptadine
What are the Beighton score cutoff points for diagnosis of hypermobile EDS?
at least 5 for pubertal and at least 6 for pre-pubertal
What medication has been shown to reduce joint pain in hypermobility spectrum disorders?
low-dose naltrexone
How do trigger points look under US?
focal ellipsoidal hypoechoic areas
What is the hallmark of postural orthostatic tachycardia syndrome?
sustained tachycardia with position change without hypotension with frequent pre syncopal episodes
What are 3 psychological findings associated with POTS?
depression, anxiety, pain catastrophizing
What are two medications used to treat POTS?
fludrocortisone and midodrine
What are the most frequent locations of noncrisis pain in SCD?
lower extremity long bones, low back
What are the most frequent locations for crises related pain in SCD?
head, neck, and chest
What is dysfunctional in a child with functional somatic symptoms?
stress regulation
What are the best types of interventions for children with functional somatic symptoms and inhibitory patterns of attachment?
getting child to focus on their own needs
What are the best types of interventions for children with functional somatic symptoms who utilize coercive strategies?
Focus on self-efficacy
Do symptoms resolve before or after restoring function when treating functional somatic symptoms disorders?
symptoms of pain, fatigue, and nausea are typically the last to improve long after function is restored
What 4 factors are related to poor outcomes in treatment of chronic pain?
female, high fear of pain, depression, anxiety
What is one of the first goals in treating chronic pain?
improving sleep
In the setting of chronic pain, do higher levels of parental distress result in poorer child functioning?
yes
What type of exercise is helpful for juvenile fibromyalgia?
aerobic
Dysfunction to what area of the brain does research suggest is involved in FND?
premotor
What are 4 inputs to the premotor area of the brain?
emotions, attention, belief, and introceptions
What are two ways to characterize symptoms in FND?
variable and distractible
What is a positive Hoover’s test?
involuntary hip extension of the weak leg with voluntary hip flexion of the strong leg against resistance
Three pillars of treatment of functional weakness?
education (explain diagnosis), movement retraining (PT/OT), self-management (psychotherapy
What is alexithymia?
inability to identify emotions experienced by self and others (seen in FND)
At what age does FND usually start to present?
school-age
