Chronic pain conditions

Question 1

What is chronic pain?

Answer 1

• NICE guidelines - Any pain that persists or recurs for more than 3 months- this includes chronic pain with an underlying condition (chronic secondary pain) and chronic pain with no underlying condition (chronic primary pain).
  Primary and secondary chronic pain can coexist.

Question 2

What kind of assessment should be offered to chronic pain patients?

Answer 2

Person centred in line with ICF

Question 3

What are the four mechanisms of pain

Answer 3

Nociceptive
Neuropathic
Inflammatory
Nociplastic

Question 4

What is nociceptive pain?

Answer 4

issues with tissues, usually localised

Question 5

What is neuropathic pain?

Answer 5

pain from peripheral NS, spinal or supraspinal- nerve injury, shooting, sharp, electric pain, pins and needles, numbness, pain worse at night, sleep disturbances.

Question 6

What is inflammatory pain?

Answer 6

local, morning stiffness, reduced with exercise, worse after rest, gradual onset, feverish, weight loss, gradual onset.

Question 7

What is nociplastic pain?

Answer 7

central sensitisation, LBP, accompanied by cognitive symptoms, widespread pain, fear response pain. No tissue damage/ injury but still has pain.

Question 8

What should be explored?

Answer 8

How does pain affect activity and participation-
- ADLs
- Psychological wellbeing
Employment

Question 9

What is rheumatoid arthritis?

Answer 9

a chronic inflammatory disease that affects the joints, resulting in painful, swollen, and stiff joints, symmetrical, high CRP.

Question 10

What is polymyalgia rheumatica?

Answer 10

inflammatory disease which results in muscle ache and stiffness in different parts of the body. It commonly affects the shoulders, arms, neck, and hips

Question 11

What is axial spondylosis?

Answer 11

• a form of arthritis that causes pain and swelling in the spine and the joints that connect the bottom of the spine to the pelvis. – sacroiliac joint

Question 12

What is psoriatic arthritis?

Answer 12

Psoriatic arthritis- chronic inflammation of the skin and joints, causing swollen, stiff, and painful joints. Asymmetrical, dactylitis- sausage fingers. CR

Question 13

what assessments can be done for chronic pain?

Answer 13

Slump test for sciatica / PSLR
AROM
Observations
Strength testing
Above and below joints

Question 14

What mobility exercises can be done for chronic pain?

Answer 14

Gentle movements
e.g. pelvic tilts, child pose, towel to pull LL, rod or door frame or hand for upper limb

Question 15

What education can be provided to chronic pain patients?

Answer 15

Liklihood symptoms will fluctuate over time and there may be flare ups of pain.
Possibility the reason for pain may not be identified, and that pain may not improve or may need ongoing management.

Encouragement to remail physically active for LT health benefits.

Question 16

What are strategies and exercises for chronic pain?

Answer 16

Develop a support plan – pain management- medication, meditation, exercise – reduce pain perception.
Heat- for stiffness
Cold- for inflammation.

Question 17

What are follow up instructions for chronic pain?

Answer 17

Consider psychological therapy such as CBT to manage symptoms.
Single course of acupuncture is recommended by NICE.

Question 18

What might be used to wind-up self-management in chronic pain?

Answer 18

Consider psychological therapy such as CBT to manage symptoms.
Single course of acupuncture is recommended by NICE.
Winding up:

Encourage going on walks e.g. to park
Exercise classes
- Aqua aerobics
- Yoga
- Weights classes
- Pilates
Education that exercise won’t worsen symptoms
Encourage to use activities that they enjoy
NICE guidelines on chronic pain encourage pts to remain physically active for general health benefits

NICE guideline education
Discuss with the person with chronic pain and their family or carers (as appropriate):
* the likelihood that symptoms will fluctuate over time and that they may have flare-ups
* the possibility that a reason for the pain (or flare-up) may not be identified
* the possibility that the pain may not improve or may get worse and may need ongoing management
* there can be improvements in quality of life even if the pain remains unchanged

Question 19

what is central sensitisation?

Answer 19

Hyperanalgesia - “Increased pain to noxious stimuli”
Allodynia - “Pain response to innocuous (non-noxious) stimuli”
Occurs in the dorsal horn of the spinal cord.