Chronic pain clinical conditions'

Question 1

primary vs secondary chronic pain

Answer 1

primary- disease in itself

secondary- chronic pain is a symptom of an underlying condition

Question 2

chronic primary pain syndrome 4 examples

Answer 2

• chronic widespread pain
• chronic MSK
• Chronic primary headache/orofacial pain
• chronic primary visceral pain

Question 3

Chronic secondary pain ex (6)

Answer 3

• chronic cancer related pain
• chronic post surgical/traumatic pain
• chronic neuropathic pain
• chronic secondary headache/orofascia
• chronic secondary viseral
• chronic secondary msk

Question 4

what are the key symptoms in dx of fibro (3)

Answer 4

• sleep disturbance
• fatigue
• affective dysfunctions (depression etc)

Question 5

Fibromyalgia epidemiology

Answer 5

2-10% of pop

-7x mc in females

Question 6

what things have been implicated in etiology of FM (3)

Answer 6

Neuroendocrine (HPA axis)
neurotrans (decreased serotonin, elevated substance P)
Neurosensory (central sensitization)
Genetic

Question 7

two main criteria for FM dx

Answer 7

• hx of widespread pain (involving all 4 limbs and the trunk) or at least 3m duration
• tenderness to digital palpation in 11 or 18 predetermined areas (9 semetrical) called tender points

Question 8

tx of FM

Answer 8

• education
• empowerment for self care
• exercise prog

Question 9

What is CRPS and 2 types

Answer 9

CRPS is a post traumatic disorder characterized by severe, continous pain in the affected limb

type 1: caused by initiating noxious event

type 2: caused by peripheral n injury

Question 10

what is the CRPS dx criteria (3)

Answer 10

1. contious pain
2. must report 3/4 (sensory, vasomotor, sudomotor, motor changes)
3. no other dx explains

Question 11

what are the 4 grades of surgery

Answer 11

grade 1: excision of skin
grade 2: inguinal hernia repair
grade 3: major (hyerectrou etc)
grade 4: jt replacements

Question 12

diabetic neuropathy dx

Answer 12

128hz tuning force (first sense lost)
Cotton wool
10g monofilament

Question 13

What should be the cornerstone in diabetic neuropathy tx

Answer 13

glycemic control should be the cornerstoen

Question 14

What is post herpetic neuralgia

Answer 14

• pain lasting longer than 3 m following an acute herpes infection
• spontaneous remission of pain becomes more unlikely after first 3 m

Question 15

Post herpetic neuralgia tx

Answer 15

best approach is prevention of herpes infection
-antivirals/antiinflammatory

-tens/elec acu of affected derms

Question 16

What is central neuropathic pain

Answer 16

a lesion in teh spinal cord or brain affecting the spinothalamocortical pathways

mc cause: stroke/ trauma

Question 17

4 main headaches

Answer 17

Migraine (12%)
Tension type (79%)
trigeminal autonomic cephalagias
other primary headaches

Question 18

headache red flags

Answer 18

-sudden onset headache
-worsening pattern headache
-headache w systemic illness (ER)
-focal neuro signs
-headache triggered by cough, exercison, valsalva
etc

Question 19

Tension type headache dx criteria (time, characteristics)

Answer 19

30 mins to 7 days

Astleast 2: bilateral, pressesing, mild to mod, not agrreevated by PA

Both: no nausea/vomitting + no more than one of photophobia/phonophobia

Question 20

Migrane w aura dx criteria(5)

Answer 20

• Atleast 5 attacks
• Headache lasting 4-72hrs
• Atleast 2: unilat, pulstating, mod/severe, agrevated by PA
• Atleast 1: neuasa/vimmiting, phophobia/phonophobia

Question 21

avg incidence of pain in cancer early and late stages

Answer 21

33% in early stages

70% in late stage of disease

Question 22

pain assessment in children

Answer 22

studies show that children as young as 3yo can accuratly indentify part of body where pain is how they can expericen it

Question 23

pain assessment things to look for in infants

Answer 23

• eyebrows lowered and drawn toegther
• a bulge between the eyebrows and vertical furrows in forehead
• eyes slightly closed
• cheeks raised
• open squalish moth

Question 24

mc cause of pain in elderly

Answer 24

degenerative spine disease/ OA

Question 25

Risk factors for opiod abuse

Answer 25

• fam hx of subastance abuse
• personal hx of substance abuse
• age 16-45
• history of preadolescent sex abuse
• psychological disease
• depression