Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro > Chronic Pain Management - Exam 4 > Flashcards

Chronic Pain Management - Exam 4 Flashcards

1
Q

What is acute pain? What is the associated timeframe?

A

A warning of pathology, threat, or direct insult and injury to the body.

lasts from a brief moment to 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is chronic pain? What is the associated timeframe?

A

Persistent pain that lasts longer than the course of healing, associated with a specific injury or disease process.

after 90 days of continued pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the bodies response to constant chronic versus intermittent chronic pain?

A

constant chronic: the body adapts in terms of normal BP, HR, RR

intermittent chronic: pain will imitate acute pain and the body does NOT adapt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does chronic pain affect the brain?

A

volume of gray matter decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does time to intervention have to due with success rates?

A

quicker you intervene with pain control the higher the rate of success and vice versus is true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 2 basic neurophysiologic pain mechanisms? give a brief explanation of both

A

somatosensation and nociception

somatosensation: Sensory neurons activated by physical stimulus. Perception of touch, pressure, pain.

nociception: Activation of specific neural pathways due to tissue-damage and/or
potential tissue damaging stimuli.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the basic understanding on how pain medication works?

A

Drugs decrease pain by antagonizing the effect of excitatory neurotransmitters or by stimulating production/preventing breakdown of inhibitory NT’s.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

______ is the first step in the pain signal. What is it? What is a nociceptor?

A

Nociception

The perception of a potentially tissue-damaging stimulus

Neurologic receptor capable of differentiating between noxious and innocuous stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 3 different types of primary afferent fibers?

A

A-beta

A-delta

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which primary afferent fiber?________ Thick myelination. Low threshold, mechanoreceptors. Fastest. Light touch, Pressure, hair movement. NOT usually pain.

A

A-beta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which primary afferent fiber?________ thinly myelinated. high & low threshold mechanical & thermal receptors. The first, ‘sharp’ and ‘intense’ pain sensation.

A

A-delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which primary afferent fiber?________ Unmyelinated. Free nerve endings, High threshold to thermal, mechanical or chemical insults. 75% of all afferent fibers. Prolonged, ‘burning’ that follows the initial A-delta stimulus.

A

C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where does a pain signal enter the spine cord?

A

pain enters at the dorsal root at the posterior portion of the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The neurons of peripheral sensation begin in the ________. The cell body lies outside of the CNS in the _______. The nerve then enters the spinal cord via the _______.

A

sensory receptor

dorsal root ganglia

dorsal (posterior)root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

First neuron synapse occurs at _______ (nociception from primary afferents), and _______ (A-betas, light touch)

A

spinal dorsal horn

dorsal column nuclei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Once in the spinal cord they make synaptic connections with ______ that may; cross the cord _______ & ascend (lateral spinothalamic tract), ascend ipsilaterally, descend, or take part in a _____

A

second order neurons

contralaterally

reflex arc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a reflex arc?

A

an instantaneous movement caused by the stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

watch youtube video on the anterolateral system!

A

do it!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where are 3rd order neurons found? What is the role?

A

thalamus

The thalamus processes sensory and complex motor signals; these in turn relay signals to the cortex in order to express the sensation of pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Also opioid receptors in ______area inhibits pain via endogenous or exogenous opiates.

A

periaqueductal gray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some major differences between white and gray matter?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is nociceptive pain defined as?

A

Aberrant activation of pain sensitive afferent peripheral nerves, due to noxious stimulation of somatic or visceral structures (i.e., celiac plexus.) through activation of A delta and C fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is neuropathic pain defined as? Activation of ______ by ______ increases spinal neuron sensitization which increases perception of pain.

A

Abnormal somatosensory processing in the PNS or CNS due to a primary lesion, neural injury or irritation, or dysfunction.like a burning, stabbing, electrical sensation

NMDA receptors

glutamate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

**______ When innocuous stimuli is painful; bedsheets, air, light touch.

A

Allodynia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

**______ Abnormal pain ‘like fire’

A

Dysesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

______ increased perception of noxious stimulation; hurts worse than it should

A

hyperalgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

**vasomotor changes include _____ and ______. Trophic changes include ____ and _____

A

skin temp and color

skin and nail alternations

28
Q

What is nociceptive pain mediated by? What makes it worse? Does this type of pain respond well to opiates?

A

Mediated by receptors in the viscera, bone, dermis, muscle and connective tissues

Exacerbated by positional change or activity

typically responds well to opiates

29
Q

What is neuropathic pain due to? What is this type of pain a result from? Do they typically respond to opiates?

A

Damaged or dysfunctional nerve tissue or damage to the CNS

Resultant from tissue injury or pathology induced injury

Usually not opiate sensitive

30
Q

What is nociplastic pain? do opioids help? give some examples

A

Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain

opioids typically do not help

Fibromyalgia, Restless Leg Syndrome, Chronic Fatigue Syndrome, TMJ, Irritable Bowel Syndrome

31
Q

What is Pyschogenic pain/Somataform disorder? What is it commonly linked with?

A

Persistent and chronic pain at one or more sites in which psychological factors are thought to play a role.

commonly linked to depression and pts needs to see psych

32
Q

What is the opioid risk tool? Do you want a higher or lower score?

A

questionnaire used to determine how likely the pt is to misuse opioids.

higher score is LESS likely to prescribe opioids

33
Q

Why do office use a pain agreement?

A

To encourage patient compliance. To facilitate an understanding between the patient and the doctor regarding the use of scheduled medications.

34
Q

T/F: pain agreement contracts are only used for schedule II medications

A

FALSE!! can be used for BZD and other class IV/V meds

35
Q

T/F: The pt can request to change pain medications due to itching and the provider should comply.

A

FALSE!! Ensure a policy that unless patient has significant SE/allergy that the meds will not be changed until the next refill is due.

36
Q

The pain agreement needs to be updated whenever a pt _______

A

changes pharmacies

37
Q

What is the pain 1-10 scale called?

A
38
Q

What are some additional pain questionnaires used in PM?

A

McGill pain questionnaire

Brief Pain Impact Questionnaire

39
Q

What are the pros for using the brief pain impact questionnaire? When should you use it?

A

It’s quick, easy, and accurate.
Provides a baseline to review and accurately determines response over time.

at the initial visit and update every couple months

40
Q

What is a lumbar discogram?

A

inject dye into discs and see how it looks

41
Q

**_______ pain due to a stimulus which does not normally provoke pain

A

allodynia

42
Q

**_____ a heightened response to a stimulus that causes pain

A

hyperalgesia

43
Q

**______ diminished pain in response to a normally painful stimulus

A

hypoalgesia

44
Q

What PE test would you use to check for a herniated disc? What is considered positive?

A

straight leg test: patient lays supine and raise leg 30-70 degrees

pain = positive test

45
Q

What test when preformed on the asymptomatic leg and positive would make you think herniated disc?

A

if the asymptomatic straight leg test resulted in pain would create a high suspicion for herniated disc

46
Q

What is the Patrick/FABER test? When would you use it?

A

crosses affected side, ankle on knee, compress

flexed knee to check for SI issues or hip joint pathology

47
Q

What is zygomatic joint loading?

A

rotation and flexion of spine elicits pain at contralateral facet joints

48
Q

What does foot drop/toe dragging make you think?

A

L5 root compression, peroneal nerve damage, sciatica, cauda equina syndrome

49
Q

What is the piriformis stretch? What position does the pt need to be in?

A

Lat decubitus position,

flex hip and knee of upper leg; positive if downward pressure produces pain from buttock to leg.

50
Q

What is the spurling test? What does it indicate?

A

extend, rotate and tilt head then compress head; if radicular to ipsilateral side, then possible nerve root compression in mid or lower C-spine.

51
Q

What is the axial compression test? What does it indicate?

A

compression of C-spine by pressing on the head; positive neck pain or radiation=possible DJD or upper C-spine nn impingement.

52
Q

What is the Waddell’s sign? What is it used for?

A

nonsensical/non-anatomical pain

Axial loading of skull producing low back pain

Rotation of shoulders and hips simultaneously with feet planted causing low back pain

SLRs differ when sitting or supine

53
Q

What is the Hoover’s test? When do you use it?

A

With patient supine, ask to lift weak leg. With both hands on heels, true ataxia will cause good leg to press down against your hand. Feigned weakness will not show that the good leg is supportive.

54
Q

What is the difference between ESI and TFESI?

A

ESI: steriods can float/coat multiple levels of nerve roots vs TFESI they stay at the nerve root level they were injected at, come in at the sides vs a midline approach with ESI

55
Q

What are some pros of high frequency stimulation? what are some cons?

A

newer: over-rides previous limitations of stim.
Because pain action potentials vary, it may cover more pain.

cons: Pt can still feel the paresthesia.
It can over-ride other sensory nerves causing unwanted paresthesia.
Eats a lot of power

56
Q

What are the pros of BURST stimulation?

A

Varies the waveform so it covers many different action potentials.

The patient doesn’t ‘feel’ the stimulation.
Gradually allows the pain to ‘disappear.’

Better coverage for more pathology types.
Longer battery life.

57
Q

What is the sprint peripheral stimulator?

A

Stimulation of peripheral nerves, Outpatient surgery to implant the lead and pt wears the stimulator for 2 months with the goal of permanently modulating the nerve after the stimulator is removed

58
Q

What is CRPS? What is a good pain relief option?

A

chronic regional pain syndrome

Dosal Root Ganglion stimulation (DRG)

59
Q

What are limitations of conventional SCS?

A

unspecific pain: stimulating a broad range of nerve fibers versus pain or disease specific nerves

unstable leads, sometimes leads migrate

energy loss due to CSF which demand higher outputs and impact longevity of the battery life

60
Q

Why is DRG a good therapy option to tx primary areas of pain?

A

Pain cells in DRG allow for activation without recruiting non-painful neurons

The DRG itself is a robust structure with a predictable intraforaminal location

Minimal CSF fluid and lower firing threshold of DRG neurons allow amplitudes set at the Micro-Amp level

61
Q

What is the MILD procedure? What does it treat?

A

removes a layer of the spinal ligament to open the spinal canal

treatment for pain relief from symptomatic central lumbar canal stenosis

62
Q

What are some common intrathecal medications? What is considered gold standard?

A

gold standard= morphine

other meds:
baclogen
hydromorphone
fentanyl
sufentanil
clonidine
bupivacaine
zyconotide
octreotide

63
Q

_______ mimics morphine analgesic effects but is NOT an opioid

A

zyconotide (Prialt)

64
Q

**What is the CDC recommended MME max for a pt with non-malignant pain? What are the 2 exceptions that do not have a limit?

A

50-90 MME is the MAX

pain associated with cancer and sickle cell crisis

65
Q

According to the CDC opioid prescribing guidelines, ______ worth of opioids for acute pain. Need to avoid _____ and opioids

A

3-7 days worth of opioids for acute pain

avoid concurrent BZD and opioid use

66
Q
A

Neuro (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions