Chronic pain lecture

Question 1

What are the two different types of pain?

Answer 1

Neuropathic - nerve damage

Nociceptive - tissue damage

Question 2

Describe somatic nociceptive pain.

Answer 2

Well localised - dermatomal
Sharp, aching and gnawing pain
Constant

Question 3

Describe visceral nociceptive pain.

Answer 3

Vague distribution, diffuse
Dull, cramping and digging pain
Can be periodic
Causes nausea, vomiting, sweatiness, CV symptoms

Question 4

What are the symptoms of neuropathic pain?

Answer 4

Shooting
Electric shock like
Burning
Tingling
Numbness

Question 5

What are some possible sources of lower back pain? (Disc, vertebrae, joints, muscle and ligaments)

Answer 5

Disc - bulge, rupture
Vertebrae - osteoarthritis 
Joints - facet, sacro-iliac
Muscle - paravertebral, gluteal
Ligaments - anterior and posterior longitudinal

Question 6

What kind of pain is lower back pain? (neuropathic, nociceptive)

Answer 6

Local nociceptor activation = nociceptive

Compression and inflammation of nerve root = neuropathic

Question 7

What’s the difference between somatic referred back pain and radicular pain in the leg?

Answer 7

Somatic referred pain - nociceptive pain affecting large areas of the posterior thigh
Radicular pain - neuropathic pain radiating down lower limb to the heel in a narrow band

Question 8

How can pain be measured?

Answer 8

NRS - numerical rating scale

VAS - visual analgoue scale

Question 9

Name some of co-morbidities associated with neuropathic pain.

Answer 9

Poor appetite
Anxiety 
Depression
Difficulty concentrating 
Drowsiness
Lack of energy
Difficulty sleeping

Question 10

What are the 6P’S of pain treatment?

Answer 10

Preventative 
Pathology - treat it
Physical therpaies
Pharmacotherpaies 
Procesural - analgesia
Psychologically based

Question 11

Describe the WHO analgesic ladder

Answer 11

1 - Paracetamol, NSAIDs
2- Codeine, dihydrocodeine
2-3 Tramadol
3 - Morphine, methadone, oxycodone

Question 12

What are the possible side effects of NSAIDs?

Answer 12

GI ulceration
Bleeding
Renal problems
Asthma
Decreased bone healing

Question 13

Which hormone is needed to convert codeine to morphine within the body?

Answer 13

Cytochrome P450

Question 14

What criteria must be looked at before prescribing opioids?

Answer 14

Appropriate

• pain model
• pain patient
• pain prescription

Question 15

From most to least effective, list conditions opioids can be used in.

Answer 15

Arthritis
Nueropathic pain
Lower back pain
Visceral pain
Fibromyalgia

Question 16

Name some adjuvants which can be used for neuropathic analgesics.

Answer 16

Anti-depressants
Anti-convulsants
Anti-arrhythimcs

Question 17

From least severe pain, to most severe pain, list the types of psychological treatment that can be received.

Answer 17

Clinicians explanation
Education class
Support groups
Pain management programme
1:1 psychology
1:1 psychiatry

Question 18

Describe the lumbar facet syndrome.

Answer 18

Lower back pain to groin, hip or thigh
Worse on back extension/rotation
Tender over paraspinal region

Question 19

How is lumbar facet syndrome diagnosed?

Answer 19

X-ray shows nothing

local anaesthetic to medial branch of dorsal primary rami