Chronic Pain Flashcards
Chronic Pain
- what is it?
- causes
What it is- pain of unknown origin that has persisted longer than the normal tissue healing time (>3mo)
Cause: HA, low back pain, cancer pain, arthritis, neurogenic pain
Acute Pain
- what is it?
- cause
what it is- pain that begins suddenly and is usually sharp in quality
Causes- surgery, fractures, burns, cuts
A’s of Pain Treatment Outcomes
- analgesia (no pain)
- ADLs restore
- adverse side effects (Be aware of)
- (Aberrant behaviors) make sure they stay on treatment course
Non-interventional pain management
- cognitive/behavioral: meaning of pain and coping mechanisms
- Accupuncture
- Chiropractic
Interventional Pain Management
Pharmacological:
- analgesic
- Aspirin
- NSAIDS
- Opioids
Co-Analgesics:
- Anti-depressant
- Ant-convulsant
Invasive Pain Management
Nerve Blocks
- celiac plexus
- hypogastic plexus
Intra-spinal drug delivery
Short term intrathecal or epidural infusion
Long term- implants (pain pump, spinal stimulator)
Anesthesiologic Pain Managment
Central Nerve Blocks
- Spinal
- Epidural
Peripheral Nerve Blocks
- Femoral
- Intercostal
Autonomic Nerve Blocks
- Stellate ganglion
- Lumbar sympathectomy
Special Technique Pain management
Facet Block for back pain
Cryolysis- nerve damage
Radiofrequency- facet joint/ nerve damage
Ablative Neuro-surgical procedure
KISS Priniciple in Pain management
Keep it Sweet and Simple
least invasive therapy
least costly
least # of Rxs
when ^^ fail use more costly therapies
Neuropathic Pain
- what is it?
- cause
- Symptoms
- Divided into
- Treatment
what it is- pain caused by nerve damage
cause- spinal cord injury, MS, Stroke, DM, herpes zoster
symptoms- burning/cold, pints and needles, numb and itching
divided into: Peripheral, central, and mixed neuropathic
Treatment-
- Anti-depressants (TCA a SNRI)
- Anti-convulsant (Pregabalin, Gabapentin, Carbamazepine)
- Topical Lidocain
- Opiods
Neuropathic pain vs musculoskeletal pain
Neuro- burning, stabbing, electric shock-like
Muscle- tenderness, achiness, stiffness
Trigeminal Neuralgia
- what is it?
- Causes
- Symptoms
- Treatment
What is it- affects trigeminal nerve, may be bilateral
Cause- blood vessel pressing on the nerve, MS, Trauma/Surgery, Cancer
Symptoms- -Severe stabbing pain, aching, burning, -no pain NOC, -triggered by touch, movement, drafts
Treatment-
-Meds: Carbamazepine (Tegretol), Baclofen, Gabapentin
-Surgical: microvascular decompression, radiofrequency rhizotomy, gamma knife, balloon compression
Post-herpatic neuralgia
- Causes
- Symptoms
- Treatment
Cause- viral infection from varicella
Symptoms-
- hyperasthesia (increased sensitivity)
- Paresthesia (abnormal senstation, tingle/prickly)
- Burning
- itching (pruritus)
- Skin lesions/ maculopapular rash
- Burning,stinging, unrelenting pain
- insomnia
Treatment-
- Herpes Zoster Vaccine
- Analgesics: capsacin, tramadol, fentanyl
- Anticonvulsants: gabapentin, carbamazepine
- TCA’s: Amitriptyline, Nortiptyline
Complex Regional Pain Syndrome
- what is it?
- Cause
- Symptoms
- Treatment
2 CRPS with confirmed nerve injury
What it is- chronic pain affecting one of the limbs
*Two types= #1: CRPS without confirmed nerve injury (90% of all cases)
Cause- physical trauma, fractures, sprains, soft tissue injury, limb immobilization, surgical or medical procedures
Symptom-
- prolonged excessive pain
- change in skin color (red,blue,purple)
- change in temp
- edema
- shiny thin skin
Treatment: No cure
- PT
- Psychotherapy
- Meds: NSAIDS, Steroids, Anti-convulsants, opiods
- Nerve Blocks
Stages of CRPS
1: burning throbbing sensitive to touch or cold, local edema
2: increased edema, skin thickening, muscle wasting, brawny skin
3: Limitation of movement, contracture of digits, waxy skin changes, brittle ridged nails
