Chronic pain conditions Flashcards
What is chronic pain?
- 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.
What kind of assessment should be offered to chronic pain patients?
Person centred in line with ICF
What are the four mechanisms of pain
Nociceptive
Neuropathic
Inflammatory
Nociplastic
What is nociceptive pain?
issues with tissues, usually localised
What is neuropathic pain?
pain from peripheral NS, spinal or supraspinal- nerve injury, shooting, sharp, electric pain, pins and needles, numbness, pain worse at night, sleep disturbances.
What is inflammatory pain?
local, morning stiffness, reduced with exercise, worse after rest, gradual onset, feverish, weight loss, gradual onset.
What is nociplastic pain?
central sensitisation, LBP, accompanied by cognitive symptoms, widespread pain, fear response pain. No tissue damage/ injury but still has pain.
What should be explored?
How does pain affect activity and participation-
- ADLs
- Psychological wellbeing
Employment
What is rheumatoid arthritis?
a chronic inflammatory disease that affects the joints, resulting in painful, swollen, and stiff joints, symmetrical, high CRP.
What is polymyalgia rheumatica?
inflammatory disease which results in muscle ache and stiffness in different parts of the body. It commonly affects the shoulders, arms, neck, and hips
What is axial spondylosis?
- 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
What is psoriatic arthritis?
Psoriatic arthritis- chronic inflammation of the skin and joints, causing swollen, stiff, and painful joints. Asymmetrical, dactylitis- sausage fingers. CR
what assessments can be done for chronic pain?
Slump test for sciatica / PSLR
AROM
Observations
Strength testing
Above and below joints
What mobility exercises can be done for chronic pain?
Gentle movements
e.g. pelvic tilts, child pose, towel to pull LL, rod or door frame or hand for upper limb
What education can be provided to chronic pain patients?
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.
What are strategies and exercises for chronic pain?
Develop a support plan – pain management- medication, meditation, exercise – reduce pain perception.
Heat- for stiffness
Cold- for inflammation.
What are follow up instructions for chronic pain?
Consider psychological therapy such as CBT to manage symptoms.
Single course of acupuncture is recommended by NICE.
What might be used to wind-up self-management in chronic pain?
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
what is central sensitisation?
Hyperanalgesia - “Increased pain to noxious stimuli”
Allodynia - “Pain response to innocuous (non-noxious) stimuli”
Occurs in the dorsal horn of the spinal cord.
