Chronic pain clinical conditions' Flashcards
primary vs secondary chronic pain
primary- disease in itself
secondary- chronic pain is a symptom of an underlying condition
chronic primary pain syndrome 4 examples
- chronic widespread pain
- chronic MSK
- Chronic primary headache/orofacial pain
- chronic primary visceral pain
Chronic secondary pain ex (6)
- chronic cancer related pain
- chronic post surgical/traumatic pain
- chronic neuropathic pain
- chronic secondary headache/orofascia
- chronic secondary viseral
- chronic secondary msk
what are the key symptoms in dx of fibro (3)
- sleep disturbance
- fatigue
- affective dysfunctions (depression etc)
Fibromyalgia epidemiology
2-10% of pop
-7x mc in females
what things have been implicated in etiology of FM (3)
Neuroendocrine (HPA axis)
neurotrans (decreased serotonin, elevated substance P)
Neurosensory (central sensitization)
Genetic
two main criteria for FM dx
- 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
tx of FM
- education
- empowerment for self care
- exercise prog
What is CRPS and 2 types
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
what is the CRPS dx criteria (3)
- contious pain
- must report 3/4 (sensory, vasomotor, sudomotor, motor changes)
- no other dx explains
what are the 4 grades of surgery
grade 1: excision of skin
grade 2: inguinal hernia repair
grade 3: major (hyerectrou etc)
grade 4: jt replacements
diabetic neuropathy dx
128hz tuning force (first sense lost)
Cotton wool
10g monofilament
What should be the cornerstone in diabetic neuropathy tx
glycemic control should be the cornerstoen
What is post herpetic neuralgia
- pain lasting longer than 3 m following an acute herpes infection
- spontaneous remission of pain becomes more unlikely after first 3 m
Post herpetic neuralgia tx
best approach is prevention of herpes infection
-antivirals/antiinflammatory
-tens/elec acu of affected derms
What is central neuropathic pain
a lesion in teh spinal cord or brain affecting the spinothalamocortical pathways
mc cause: stroke/ trauma
4 main headaches
Migraine (12%)
Tension type (79%)
trigeminal autonomic cephalagias
other primary headaches
headache red flags
-sudden onset headache
-worsening pattern headache
-headache w systemic illness (ER)
-focal neuro signs
-headache triggered by cough, exercison, valsalva
etc
Tension type headache dx criteria (time, characteristics)
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
Migrane w aura dx criteria(5)
- Atleast 5 attacks
- Headache lasting 4-72hrs
- Atleast 2: unilat, pulstating, mod/severe, agrevated by PA
- Atleast 1: neuasa/vimmiting, phophobia/phonophobia
avg incidence of pain in cancer early and late stages
33% in early stages
70% in late stage of disease
pain assessment in children
studies show that children as young as 3yo can accuratly indentify part of body where pain is how they can expericen it
pain assessment things to look for in infants
- eyebrows lowered and drawn toegther
- a bulge between the eyebrows and vertical furrows in forehead
- eyes slightly closed
- cheeks raised
- open squalish moth
mc cause of pain in elderly
degenerative spine disease/ OA
Risk factors for opiod abuse
- fam hx of subastance abuse
- personal hx of substance abuse
- age 16-45
- history of preadolescent sex abuse
- psychological disease
- depression
