CHRONIC PAIN Flashcards by BIJAY KENT HIRATA

A subjective and entirely individually personal experience
influenced by learning, context, and multiple
psychosocial variables

Pain

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T/F Pain serves as an adaptive function designed to protect the
organism from harm

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The one that said that pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or
described in terms of such damage

International Association for the Study of Pain

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It is a physiologic response to a “noxious” event which is time limited where in treatment should be aimed at removing the problem

Acute Pain

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A type of pain that happens 3-6 mos p the initiating event which is both psychological and behavioral

Chronic Pain

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T/F Acute pain may not be associated with ongoing noxious event or
pathologic process

F, Chronic

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Chronic pain may be associated with ______ and ______

Disrupted sleep
Declining function

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Chronic pain eventually ceases to serve any ____ role

protective

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Chronic pain can become a source of:

Dysfunctional behaviors
Suffering
Disability

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Untreated chronic pain can lead to multiple issues such as:

-Increased cost of health care
-Overuse or misuse of psychoactive medications
-Iatrogenic complications
-Increased economic and social costs

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This pain includes repeated episodes of acute pain such as recurrent episodes of back pain

Recurrent pain

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T/F Recurrent pain may also include Acute pain where symptoms are intermittent such as migraine HA

F, Chronic

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A chronic biopsychosocial disease characterized
by impaired control over drug use, compulsive
use, continued use despite harm, & craving

Addiction

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Medications whose primary indication is a condition other than pain but have demonstrated benefit in pain mx

Includes antidepressants, anti convulsants, corticosteroids, neuroleptics, etc.

Adjuvent medication

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Pain caused by a stimulus that does not
normally provoke pain (e.g. pt perceives touch as pain)

Can occur d/t medical disorder, result of past trauma/injury, or present idiopathically by itself (Fibromyalgia, Migraine, postherpic neuralgia)

Allodynia

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Absence of pain in response to stimulation that
would normally be painful

Analgesia

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A syndrome of sustained burning pain, allodynia,
& hyperpathia after a traumatic nerve lesion,
often combined with vasomotor & sudomotor
dysfunction (such as diabetic autonomic
neuropathy) & later trophic changes, such as in
the skin & connective tissues in the area

Causalgia

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Pain initiated or caused by a primary lesion or
dysfunction in the central nervous system; pain
that the brain thinks is in the area but it’s not
there anymore

Central Pain

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Pain that exists when individuals have developed
extensive pain behaviors, such as preoccupation
with pain, passive approach to health care,
significant life disruption, feelings of isolation,
demanding, angry, or doctor-shopping

Chronic Pain Syndrome

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A maladaptive pattern of drug use marked by
tolerance & a drug class-specific withdrawal
syndrome that can be produced by abrupt
cessation, rapid dose reduction, decreasing
blood levels of drug, or administration of an
antagonist

Dependence

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An unpleasant abnormal sensation, whether
spontaneous or evoked
Feels like a shock, burning, or tightening

Dysesthesia

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An increased response to a stimulus that is
normally painful

Hyperalgesia

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Increased sensitivity to stimulation (most likely,
touch), excluding the special senses

Hyperesthesia

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Pain associated with cancer

Malignant pain

Pain initiated or caused by a primary lesion, dysfunction, or transitory perturbation in the peripheral or central nervous system

Neurogenic Pain

Pain initiated or caused by a primary lesion or dysfunction in the nervous system

Neuropathic pain

The opposite of a placebo or the placebo effect. A nocebo is an inert treatment or event that increases Sx because the patient believes it will increase Sx. The expectation of pain can result in both increased pain from painful stimuli & allodynia, pain from a normally non painful stimulus

Nocebo effect

A receptor preferentially sensitive to a noxious stimulus that would become noxious if prolonged

Nociception

Refers to the affective component of pain. Suffering includes both emotional (e.g., anxiety & anger) & cognitive (e.g., thoughts of helplessness) components, & may be d/t a combination of unpleasantness & catastrophizing (making a “catastrophe” out of minor issues)

Suffering

Musculoskeltal causes

Spinal pain Headaches Arthritis

Other causes

Stroke Spinal Cord Injuries Multiple Sclerosis HIV/AIDS Cancer

This model of pain indicates that tissue damage causes pain sensations. This also works for acute pain

Traditional model of pain

Traditional model is unable to explain other examples of pain where no damage could be found

Physical factors interact with personal and environmental factos to affect body function and structure, activity, and participation in life activities

Biopsychosocial

This happens when patients have developed extensive pain behaviors. It can be considered a disease rather than a symptom affecting ALL aspects of life

Chronic Pain Syndrome

T/F CPS should address primary pathology and perpetuating factors

F, secondary

CPS RX should address:

peripheral and central sensitization, disinhibition, anxiety, catastrophizing, fear avoidance, etc.`

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According to this approach, acute pain is primarily nociceptive wherein Mechanical, thermal, chemical, and free nerve endings in the periphery transmit information about noxoius stimuli via different nerves

Integrated Biobehavioral Approach

2 Different brain areas process different types of pain: A. SI Somatosensory Cortex B. SII Somatosensory Cortex 1. Sensory discriminatory aspect of pain 2. Recognition, learning, and memory of pain events

A B

This processes pain and unpleasantness which contributes to affect, cognition, and response selection

Anterior Cingulate Cortex

This area mediates autonomic responses o noxious stimulation and is considered to be the ________ component of pain related memory and learning

Insula AFFECTIVE

This is a complex network of synaptic links initially determined by genetics which is modified by psychological and sensory inputs both before and during the pain experience

Pain Neuromatrix

Pain neuromatrix is wherein pain is a complex web of interactions modulated by both _____ and _____ physical & psychological states

current previous

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This theory is proposed by Melzack and Wall which talks about how a nonpainful stimulus can decrease the perception of pain

Gate Control Theory

According to The Gate Control Theory, it is a ______control in wounded athletes & soldiers

Descending

In the Gate control theory, it is mediated by _______ and descending ______ connections

Norepinephrine Noradrenergic

Melzack proposed the neuromatrix to explain how the pain experience is mediated by multiple factors

This pathway travel through the Dorsal funiculus

Dorsal Inhibitory Pathways

In the Dorsal Inhibitory Pathways, neurotransmitters secreted in the dorsal horn:

Noradrenaline Acetylcholine Serotonin Glycine

_________ factors modify activity of the pain pathways in all levels of the nervous system

Descending inhibitory

_______ sensitivity can be reversed by ________ (antagonist)

Opioid Naloxone

Modulaters in the GCT

Placebo, antidepressants, anticonvulsants

In the GCT, structures involved:

Hypothalamus Amygdala Periaqueductal grey area (PAG) Rostral ventromedial medulla (RVM)

This is the decreasing modulationwhich can increase pain as well as inhibit it. The expectation of pain can result in both increased pain from painful stimuli but also allodynia

Nocebo effect

Nocebo effect can be mediated by:

Caudal anterior cingulate cortex Head of the caudate Cerebellum Contralateral cuneiform nucleus

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Afferent nociceptive input is increased through a decreased threshold, increased responsiveness and/or increased receptive field

Peripheral Sensitization

In peripheral sensitization, inflammatory mediators include:

Cytokines Prostaglandins Serotonin

T/F For peripheral sensitization, Injury sensitizes the nerve through either inflammation witihin the neural connective tissue or indirect compromise of the axons

F, direct

Inflammation in the CNS causes increased sensitization by increasing excitability in the dorsal horn

Central Sensitization

Central sensitization may result in:

hyperalgesia, allodynia, aftersensations, summation

T/F Central sensitization provides a physiologic explanation for pain in the presence of identifiable injury

F, absence of identifiable injury

Central sensitization is a ______mechanism for pain during stress or psyche

Physical

T/F Central sensitization can be maintained by ongoing nociceptive input or be independent of nociceptive input

Central sentization can occur in the ff:

SC, RVM, amygdala, anterior cingulate cortex, and trigeminal brainstem complex

This are Repeated low-frequency nociceptor stimulation results in progressively increased action potential in the dorsal horn cells

Wind-up

T/F Wind up can cause short-term potentiation

F, long-term

Central sensitization can occur in conditions such as:

Fibromyalgia Widespread myofascial pain Chronic headache TMJ disorders Neuropathic pain

Occurs when the pain fiber synapses with the seconday neuron in the dorsal horn is amplified, resulting in the firing of the secondary neuron with lower peripheral stimulus

Hyperalgesia

Decreased firing threshold or decreased inhibition

Short-term allodynia

Includes sprouting of A Alpha and Beta fibers to synapse with nociceptor fibers causing sensory input to be pain

Long-term allodynia