Chronic Pain Flashcards
S3Q3
PAIN: Intro
epidemiology - sex, what as common cause of PE, more than (3), physio (4)
lifestyle - smoking lead to (2), sleep disturbance (1=1), nutritional
EPIDEMIOLOGY
- F>M
- LBP as 2nd cause of PE
- pain > DM, heart disease, cancer
- physio: fMRI, gene, cortisol, HP
LIFESTYLE
- smoking = immediate analgesia via central & peripheral
- sleep: 15m poor quality = pain
- nutritional: lack of vitamin D
PAIN: Intro
flags - red (1=2), orange (1), yellow (3=2) (1=4) (1=1), blue (1=1), black (1)
pain acronyms + (4) for peripheral & (1) for central
fast vs. slow pain structures (2.5)
FLAGS
- red: severe physical (tumor, fx)
- orange: psych
- yellow: judgement appraisal belief (negative beliefs & expected outcomes), emotional response (fear catastrophe distress anxiety), pain response (tx dependent)
- blue: work
- black: systemic
PAIN
- PQRST, SOCRATES
- sclerotome, dermatome, referred pain, peripheral = structural specific
- symmetrical autonomic sx = central neurogenic
- fast pain: direct connection to thalamus & cortex
- slow pain: thalamus, hypothalamus, limbic, RF, PAG
PAIN: Intro
acute pain - d/t what, tx should what, time
chronic pain - time, d/t (2), if untreated (2), associated (2)
recurrent pain - 2 examples
suffering - what, 1+1=1
ACUTE PAIN
- nociceptive d/t noxius stimuli = tx problem
- time limited
CHRONIC PAIN
- 3-6m
- ongoing + d/t psych, behavioral
- untreated = iatrogenic complications (illness d/t exams), opoiod dependency
- associated: sleep disturbance, dysfunction
RECURRENT PAIN
- acute recurrent (LBP), intermittent chronic (LBP)
SUFFERING
- affective component of pain
- emotional + cognitive = catastrophe
PAIN: Intro
biopsychosocial model - traditional, factors (3)
chronic pain syndrome - if pain is what then what, tx (2.4)
pain neuromatrix - what, determined by (2)
CPS tx: anxiety
BIOPSYCHOSOCIAL MODEL
- traditional: can’t explain pain if no tissue injury
- factors: physical, personal, environmental
CHRONIC PAIN SYNDROME
- if pain behavior is extensive = disease not sx
- tx: central & peripheral, anxiety catastrophe disinhibition fear
PAIN NEUROMATRIX
- synaptic links determined by genetics then later on psychological & sensory inputs before & during painful experience
PAIN: Intro - Integrated Biobehavioral Approach
transmission of signals how
SI somatosensory (2), SII (3), ant cingulate (2=3), insula (2)
- receptors at periphery transmit info about stimuli via nerves
- SI somatosensory: sensory discrimination, localization
- SII somatosensory: recognition, memory, learning of pain
- ant cingulate cortex: pain & unpleasantness = cognitive, affect, response
- insula: mediate autonomic (inc BP), affect component of learning & memory
PAIN: Gate Control
(3) = dec pain
dorsal inhibitory pathway - via what structure, neurotransmitters (4), opioid reversed by, modulators (3), structures (4)
nocebo effect - (2) = (2), mediated by structures (4)
NT: SANG, structures: HARP, nocebo: C
- nonpainful stimuli + norepinephrine + noradrenaline = dec pain perception
DORSAL INHIBITORY PATHWAY
- via dorsal funiculus
- NT: serotonin, ACh, noradrenaline, glycine
- opioid: reversed by naloxone
- modulator: placebo (can have good effect), antidepressant, anticonvulsant
- structures: hypothalamus, amygdala, rostral ventmed medulla, periventricular greay
NOCEBO EFFECT
- nocebo: real tx bad effect
- dec pain modulation & expect pain = inc pain & allodynia
- mediated by: ant cingulate cortex, contralateral cuneiform nucleus, head of caudate, cerebellum
PAIN: Peripheral Sensitization & Neurogenic Pain
afferent nociceptive input is increased via (3)
inflammatory mediators - effect, (3)
injury sensitizes nerve how
peripheral neurogenic pain - sx (6), nerve as source of pain d/t structures (2), can extend initial via (2), causalgia d/t what + sx (3.3)
inflam: cytokinin, sx: hyposthesia
PERIPHERAL SENSITIZATION
- afferent nociceptive input is increased by: dec threshold, inc receptive field, inc responsiveness
- inflammatory mediators (inc pain = protective): cytokinin, prostaglandin, serotonin
- injury cause inflamed neural CT or direct axon = sensitize nerve
PERIPHERAL NEUROGENIC PAIN
- sx: hyposthesia, anesthesia, paresthesia, dysesthesia, pain, weakness
- nerve as source of pain d/t neural CT & nervi nervotum
- extend site via peripheral sensitization & glial cells releasing growth factors
causalgia (CRPS)
- d/t nerve lesion = hyperpathia (pain syndrome), allodynia, burning pain -> vasomotor, sudomotor, trophic
PAIN: Central Sensitization
inflamed CNS = what = what = sx (4)
explains why
occur in what structure (6)
wind up - stimulus = what = what
hyperalgesia - stimulus = what
short term - d/t what, result
long term allodynia - what = what
ANS - what = what, HPA axis (2=1)
structure: 2 dorsal 1 nocebo
- inflamed CNS = dorsal horn activate = AP = hyperalgesia, allodynia, after-esensations, summations
- explain why pain even after injury
- occur in: amygdala, RVM, SC, ant cingulate cortex, trigeminal brainstem cortex
- wind up: repeated low frequency nociceptive stimuli = more AP from dorsal horn = long term potentiation (pain)
- hyperalgesia: activate dorsal horn = peripheral firing = pain
- short-term allodynia: d/t inflammation; dec firing threshold
- long-term allodynia: alpha a & beta fibers sprout with nociceptor = pain
ANS
- sympathetic afferents sprout with nociceptor = direct SC activation
- HPA axis: physical or emotional stress = chronic sympathetic activation of chronic pain
PAIN: Classification
sensory discriminative, motivational affective (2), cognitive affective (2)
nociceptive pain - d/t what stimulus = what = what
inflammatory pain - d/t (2) = purpose, become counterproductive
maladaptive pain - d/t what, lead to (1=1), conditions (4)
- sensory discriminative: describe pain
- motivational affective: emotion + physio (nausea)
- cognitive affective: interpretation based on culture & experience
NOCICEPTIVE PAIN
- d/t noxious stimuli = send signal of impending pain = withdraw (protective)
INFLAMMATORY PAIN
- d/t pathology or peripheral injury = discourage use = protective
MALADAPTIVE PAIN
- d/t abnormal neural
- lead to dec usage = dec repair
- conditions: tension headache, fibromyalgia, IBS, TMJ
PAIN: Classification
muscle pain - trigger point d/t (6) + lead to (1.3), widespread myofascial pain what (2)
central neurogenic pain - d/t what, conditions (4), sx (x.2), HPA axis d/t conditions (4), mechanism + structure + mediated by (4)
shit that increase pain, decrease pain
MUSCLE PAIN
- trigger point: d/t idiopathic, OA, RA, TMJ, chronic tension headache, FM; referred pain + tinnitus, blurred vision, paresthesia
- widespread myofascial pain syndrome: central & peripheral
CENTRAL NEUROGENIC PAIN
- d/t injured CNS via stroke, FM, TBI, MS
- sx: burning aching lancinating pricking; hyperalgesia & allodynia
- HPA axis: d/t FM, IBS, PTSD, burnout
descending facilitation
- ventlat funiculus
- mediated by: opioid, serotonin, cholecystokinin, norepinephrine
- shit that inc pain: serotonin, glutamate (gabapentin & ketamin), substance P, growth factor
- shit that dec pain: serotonin, GABA, opioid, cannabinoids
PAIN: Coping
good vs. bad coping
anxiety - what
fear avoidance - what
catastrophizing - (4), trend (2)
stress - produce what, works through (2) via (1), structures (5)
- good coping: task persistence, ignore pain, distract
- bad coping: venting, resting, guarding, avoid movement, ask assist
- anxiety: normal in acute pain; protective
- fear avoidance: kinesiophobia
catastrophizing
- helpless, pessimism, rumination, magnification
- strongest & most consistent factor of pain & function
stress
- produce analgesia through opioid & non-opioid mechanisms via descending inhibition
- structures: muscle atrophy, cognitive, compromised tissue growth, autonomic, immune
