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
Primary and Secondary HA
1: chronic HA syndromes- not life threatening»> tension, migraine, cluster, JMJ
2: Causes by other means (whiplash), sudden onset, may be life threatening»> SAH, Meningitis, Neoplasm, Stoke
Warning Signs of HA pain
- *Worse HA of life (thunderclap»SAH)
- new or unusual HA
- Sensory/motor deficits
- HA d/t trauma (SDH)
- Constant and unremitting
- stiffness of neck, fever (meningitis)
- affects vision, speech, personality
Tension HA
- periodicity of occurrence
- symptoms
- cause
- drugs
- prevention
- most common
Symptoms-bilateral steady pressing, tightening (NON throbbing) pain in upper back and neck, base of head, ears and above ears, jaw, just above the eyes
Cause- sleep deprivation, stressful position/bad posture, muscle tension
Drugs-
- Aspirin
- Acetaminophen
- NSAIDS
- NSAIDS + Caffiene
- Adjunct therapy (Butalbital- barbituate)
Migraine HA
- periodicity of occurrence
- symptoms
- cause
- Treatment
- triggers
- preventative treatment
occurrence: 4-72 hours
symptoms: -unilateral -throbbing/pulsating -moderate/severe -nausea/vomiting -photophobia/phonophobia -w/ or w/o aura -start mild and get worse -
Cause- dilation of blood vessels innervated by the trigeminal nerve
Treatment:
- Aspirin, Acetaminophen, NSAIDS, indomethacin
- Zolmitriptan, Sumatriptan, Rizatriptan
- Phenergan, zofran (vomiting)
Triggers:
- skipping meals
- too little or too much caffeine
- sleeping too much or too little
- stress
Preventative Treatment:
-TCAs
Amitriptyline/Notriptyline
-Beta Blockers
Propranolol
-Ca Channel Blockers
Verapamil
Cluster HA
- periodicity of occurrence
- Triggers
- symptoms
- Treatment
Periodicity- 1-2 attack/day for 6-12wks, may go 6mo free
Triggers-
- ETOH
- Stree
- Glare
- Foods
Symptoms:
- Ice pick pain
- HA one side, around eye
- Watering eye
- Nasal Congestion
- Rhinorrhea
- ipsilateral Lacrimation (one eye tearing)
Treatment
- Inhalation of 100% O2
- Triptans
- Prophylactic: Verapamil
Temporo-Mandibular Syndrome -Periodicity -Symptoms -Treatment -
Periodicity- constant pain d/t nocturnal buxism (teeth grinding) and teeth clenching
Symptoms- unilateral pain in mastication muscles
- pain in ear, jaw, post cervical
- Dull ache worse w/ chew
- HA
- Lock jaw
Treatment-
- muscle relaxant
- NSAIDS
- TCA
- Botox into masticatory muscles
- Jaw exercises
- Mouth guard
- dental care
- avoid stimulants (caffeine, decongestants)
