Chronic pain syndrome Flashcards

1
Q

What is the most common cause of long-term disability, with lost work days, in the US?

A

pain

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2
Q

What does persistent pain cause?

A

fxnal impairment and disability, psychological distress, and sleep deprivation. affects the quality of life

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3
Q

Define chronic pain

A

no biological value, has persisted beyond the normal tissue healing time

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4
Q

What does the DSM define chronic pain as?

A

persistent pain for six months

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5
Q

What are the three types of pain?

A

adaptive, inflammatory, maladaptive

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6
Q

Define adaptive pain

A

contributes to survival by protecting the organism from injury and promoting healing

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7
Q

Define inflammatory pain

A

preceded by injury at cellular level.

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8
Q

Define maladaptive pain

A

pain as a disease, abnormal sensory process, persisten or recurrent

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9
Q

Define hyperesthesia

A

increased sensitivity to stimulation, excluding the special senses

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10
Q

define dysethesia

A

an unpleasant abnormal sensation whether spontaneous or evoked

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11
Q

Describe psychogenic pain

A

physical pain that is caused, increased or prolonged by mental, emotional, or behavorial factors

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12
Q

What are some of the most common psychogenic pains?

A

headache, back pain, or stomach pain

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13
Q

Describe phantom pain

A

felt in a part of the body that has been lost or from which the brain no longer receives signals. a type of neuropathic pain

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14
Q

describe breakthrough pain

A

pain that comes on suddenly for short periods of time and isn’t alleviated by the patient’s normal pain management

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15
Q

What type of patient is likely to have breakthrough pain?

A

cancer patients

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16
Q

describe mixed chronic pain

A

may be mixed neuropathic/nociceptive pain present with advancing and changing disease.

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17
Q

What type of disease states are associated with mixed chronic pain?

A

migraines, cancer

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18
Q

What are the principles of chronic pain management?

A

An accurate diagnosis of pain syndromes, formation of a treatment plan

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19
Q

What are some goals of pain therapies?

A

reduction in intensity of pain, improvement of physical fxning, improvement of emotional fxning, improvement of quality of life, maintain dignity

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20
Q

What are the A’s of pain treatment outcomes?

A

analgesia, activities of daily living, adverse effects, aberrant behaviors

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21
Q

What are four types of pain therapies?

A

cognitive/behavioral, functional restorative, pharmacologic, interventional

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22
Q

Describe cognitive/behavioral aspects of pain management.

A

deals with the meaning of pain, the emotional background, and coping skills

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23
Q

When are invasive procedures used to treat pain?

A

when pain or SE persist despite comprehensive trials of pharmacologic therapy

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24
Q

What are some invasive procedures used to treat pain?

A

neurolytic blocks (celiac or hypogastric plexus), intra-spinal drug delivery, anesthesiologic

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25
Q

What are the different anesthesiologic pain treatments?

A

central nerve blocks (spinal, epidural), peripheral nerve blocks (femoral, intercostal, ect), autonomic nerve blocks (stellate ganglion, lumbar sympathectomy)

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26
Q

What are some special techniques of pain therapies?

A

facet block, cryolysis, radio frequency, ablative

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27
Q

What is a facet block used to treat?

A

back pain

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28
Q

What is cryolysis used for?

A

nerve damage

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29
Q

What is radio frequency used to treat?

A

facet jt/nerve damage

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30
Q

What are some nociceptive pain disorders?

A

low back pain, myofacial pain, visceral pain, headache, TMJ

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31
Q

What are some neuropathic pain disorders?

A

post herpetic neuralgia, trigeminal neuralgia, complex regional pain syndrome, phantom pain

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32
Q

What are some of the major causes of low back pain?

A

prolapse inter-vertebral disc, facet jt degeneration, sacroiliac jt arthritis, musculoskeletal disorder,

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33
Q

What are some red flags of low back pain?

A

loss of bowel/bladder control, fever, saddle parathesia

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34
Q

What are some musculoskeletal causes of myofascial pain?

A

abnormal muscle stress, poor posture or static position for prolonged period

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35
Q

What are some vitamin deficient causes of myofascial pain?

A

anemia, low Ca/Mg/K, low vitamins C, B-1/6/12

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36
Q

What are some miscellaneous disorders that can cause myofascial pain?

A

radiculopathy, visceral diseases, depression, hypothyroidism, hyperuricemia, hypoglycemia

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37
Q

What are some treatments for myofascial pain syndrome?

A

massage therapy using trigger-pt release, physical therapy, pharmaceuticals

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38
Q

What are some primary headaches?

A

migraines, cluster, tension, TMJ, Sinus, medication overuse

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39
Q

What are the causes of secondary headaches?

A

caused by other means-whiplash injury, subarachnoid hemorrhage, meningitis, neoplasm, stroke, acute HTN crisis

40
Q

What are some danger signs associated with headaches?

A

Worst HA of life, new symptom, sensory or motor deficits preceding HA, unilateral HA, HA due to trauma, constant/unremitting

41
Q

What are some dangerous tension symptoms associated with HAs?

A

steadily increasing, worse in the morning, accompanied by vomiting, H/O cancer, personality changes, older than >60

42
Q

What are some dangerous family history diseases associated with HA?

A

cerebral aneurysm, other vascular anomalies, polycystic kidneys

43
Q

Describe tension headaches.

A

most common type. pain can radiate from lower back of head, the neck, eyes or other muscle grps

44
Q

What are some precipitating factors of tension HAs?

A

sleep deprivation, bad posture, eyestrain, muscle tension around the neck/head

45
Q

What are the 3 main types of tension HAs?

A

infrequent episodic, frequent episodic, chronic

46
Q

What is the duration of an infrequent episodic HA?

A

episodes less than one day a month

47
Q

What is the duration of frequent episodic HA?

A

episodes 1-14 days a month

48
Q

What is the duration of chronic HA?

A

episodes >15 days a month

49
Q

What are some diagnostic characteristics of tension HA?

A

pain is bilateral, quality of pain is steady, intensity of pain is moderate, no aggravation with physical activity

50
Q

What are some medications used to treat tension HAs?

A

aspirin, tylenol, NSAIDS, muscle relaxers (valium, robaxin), anti-anxiolytic (hyroxyzine)

51
Q

What are some non pharmacologic treatments for tension HA?

A

behavioral health, chiropractic, massage therapy, biofeedback

52
Q

Describe migraine HA

A

episodic disorder. characterized by severe HA associated with nausea, light/sound sensitivity

53
Q

What are the 4 phases of migraine HAs?

A

premonitory, aura, HA, postdromal

54
Q

What are some triggers of migraines?

A

skipping meals, too little/much caffeine, too little/much sleep, certain foods (red wine, chz), OCP, periods

55
Q

What are some mild treatments of migraine HAs?

A

ASA, tylenol, NSAIDS, indomethacin

56
Q

What are some stronger med treatments for migraine HAs?

A

zomig, maxalt, imitrex

57
Q

What can you prescribe for nausea and vomiting with HA?

A

phenergan, zofran

58
Q

What are some preventative meds for migraines?

A

tricyclic antidepressants (amitriptyline, nortriptyline), beta blockers (propanolol), calcium channel blockers

59
Q

What is the pathophysiology of cluster headaches?

A

vascular headache disorder, primarily affects middle aged men

60
Q

What is the periodicity of cluster headaches?

A

repetitive HA occurring regularly for weeks to months, usually at night. 1-2 attacks/day for 6-12 weeks, then 6-12 months free

61
Q

What are some triggers of cluster headaches?

A

ETOH, stress, glare, foods

62
Q

What are some clinical manifestations of cluster headaches?

A

unilateral pain initiating around eye, max intensity in minutes, deep/excruciating pain, ipsilateral lacrimation, redness of eye, nasal congestion, sweating, pallor

63
Q

How long do cluster headaches usually last?

A

15 minutes to 3 hours

64
Q

What are some acute treatments for cluster HA?

A

inhalation of O2, triptans, GH antagonists (sandostatin)

65
Q

WHat are some prophylactic measures for cluster HA?

A

verapamil, prednisone, lithium, ergotamine, indomethacin

66
Q

What is the periodicity of TMJ syndrome?

A

fairly constant pain usually in young women related to nocturnal bruxism and teeth clenchn

67
Q

What are some manifestations of TMJ syndrome?

A

unilateral pain in mastication muscles, dull ache worsened by chewing, audible clicking during movt, jaw locking, pain can radiate to ear, jaw, post cervical area

68
Q

What do you see on physical exam with TMJ?

A

tenderness inside the tragus of affected side

69
Q

What are some differential diagnoses of TMJ syndrome

A

infection, RA, temporal arteritis, dental, trigeminal neuralgia, parotid gland disorder

70
Q

What are some medications used to treat TMJ?

A

muscle relaxants, NSAIDS, tricyclic antidepressants, corticosteroid injections, botulinum toxin

71
Q

What are some prophalactic treatments of TMJ?

A

jaw excercises, eliminate nocturnal jaw clenching, correct aggravating factors, dental care, avoid stimulants

72
Q

What are some treatments of neuropathic pain?

A

pregabalin, capsaicin, controlling diabetes

73
Q

What is the pathogenesis of post herpetic neuralgia?

A

nerves involved w/infection of acute herpes are inflamed, lies dormant

74
Q

What are some signs/symptoms of post herpetic neuralgia?

A

thoracic, trigeminal, cervical sites. sharp, burning, stabbing pain, areas of anesthesia, impaired sleep, anorexia

75
Q

What is the prevention for post herpetic neuraglia?

A

Herpes zoster vaccine

76
Q

What are some medications used to treat post herpetic neuralgia?

A

tramadol, gabapentin, carbamazepine, TCAs

77
Q

What is the surgical treatment used to treat post herpetic neuralgia?

A

peripheral nerve block

78
Q

What is the pathogenesis of trigeminal neuralgia?

A

usually compression of nerve root by loop of artery or vein. cysts, neuroma, AV malformation. compression leads to demylination and ectopic transmission

79
Q

What are some signs/symptoms of trigeminal neuralgia?

A

unilateral facial pain near mouth that shoots toward ear, asymptomatic at night, triggered by touch, movt drafts, eating, episodes become more frequent

80
Q

When should an MRI be done with trigeminal neuralgia?

A

patients w/sensory loss, patients < 40 yr, patients with bilateral symptoms, patients that don’t respond to conservative treatment

81
Q

What are some medications used to treat trigeminal neuralgia?

A

carbamazepine, valproic acid, baclofen, gabapentin

82
Q

What are surgical treatments for trigeminal neuraglia?

A

microvascular decompression, radiofrequency rhizotomy

83
Q

What do complex, regional, pain, syndrome represent in the CRPS acronym?

A

complex- varied/dynamic clinical presentation. regional- non dermatomal distribution of symptoms. pain- out of proportion to the inciting events. syndrome- constellation of symptoms and signs

84
Q

Define CRPS

A

disorder of extremities characterized by pain, swelling, limited ROM, vasomotor instability, skin changes and patchy bony demineralization

85
Q

Define type I CRPS

A

without definable nerve lesion, 90% of cases

86
Q

Define type II CRPS

A

with definable nerve lesion, 10% of cases

87
Q

What is the clinical presentation of CRPS?

A

triad of symptoms. spontaneous pain- burning, aching, throbbing, shooting or deep pressure. motor changes- weakness, distal tremors, dystonia, myoclonus

88
Q

Describe stage I of CRPS?

A

with or without apparent cause, pt develops limb pain

89
Q

Describe stage II of CRPS?

A

progession of edema, thickening of skin, muscle wasting, brawny skin. lasts 3-6 months

90
Q

Describe III of CRPS?

A

limitation of movt, contracture of digits, waxy trophic skin changes, brittle ridged nails

91
Q

What are some differential diagnoses of CRPS?

A

RA, thoracic outlet syndrome, scleroderma

92
Q

What is prevention of CRPS?

A

treat underlying disorder, early mobilization after injury

93
Q

What is management of CRPS?

A

physical therapy, antidepressants, prednisone, regional nerve blocks

94
Q

What is the pathogenesis of phantom pain?

A

occurs when nerves that would normally innervate the missing limb cause pain

95
Q

What are some symptoms of phantom pain?

A

tingling, itching, burning, aching

96
Q

What are managements of phantom pain?

A

analgesic and antidepressants