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Pain > Chronic Pain Syndrome > Flashcards

Chronic Pain Syndrome Flashcards

1
Q

Neuropathic Pain

A

Caused by damage or disease affecting any part of the nervous system involved in bodily feelings.
Bumping the ‘funny bone’ elicits acute peripheral neuropathic pain

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2
Q

Psychogenic Pain

A

Physical pain that is caused, increased or prolonged by mental, emotional or behavioral factors.

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3
Q

Phantom Pain

A

Felt in part of the body that has been lost or from which the brain no longer receives signals.
A type of neuropathic pain.
Analgesic and anti-depressants are effective in early phase.

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4
Q

Breakthrough Pain

A

Pain that comes on suddenly for short periods of time and is not alleviated by the patients normal pain mgmt.
Common in cancer Pt’s.

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5
Q

Nociceptive Pain

A

Caused by stimulation of peripheral nerve fibers that respond only to stimuli approaching or exceeding harmful intensity.

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6
Q

Mixed chronic pain

A

A mixture of neuropathic and nociceptive pain.
Migraines and Cancer
The source changes with the progression of the disease process.

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7
Q

Mgmt of chronic pain is founded on

A

An accurate dx of pain syndromes.

Formation of a tx plan.

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8
Q

The 5 goals of pain therapies.

A 
Reduction of intensity of pain
Improvement of physical functioning
Improvement of emotional functioning
Improvement of quality of life
Maintain dignity
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9
Q

The 4 A’s of treatment outcomes

A

Analgesia
Activities of daily living
Adverse effects
Aberrant (unacceptable) behavior

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10
Q

Non-interventional Pain Mgmt

A

Cognitive/behavioral. Deals with the meaning of pain, the emotional background and coping styles and mechanisms.
Psych and behavioral medicine
Exercise, PT, Group Therapy
CAM (acupuncture, chiro)

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11
Q

Interventional Pain Mgmt

A

Pharmacological: Analgesic, ASA (aspirin), NSAIDS, Opioids.

Co-Analgesics: Anti-depressants, Anti-convulsants

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12
Q

Invasive procedures

A

When pain or side effects persist despite other therapy.

  • Nerve blocks
  • Intrathecal/epidural infusion (short term)
  • Implants (long term)
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13
Q

Central Nerve Blocks

A

Spinal and Epidural

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14
Q

Peripheral Nerve Blocks

A

Femoral, Intercostal, others.

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15
Q

Autonomic Nerve Blocks

A

Stellate ganglion, Lumbar Sympathectomy

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16
Q

KISS principle

A

Keep it Sweet and Simple

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17
Q

Low Back Pain

A

Most common condition seen in pain clinic.
-Prolapse disc, facet degen., SI joint arthritis
Pain alone may not justify surgery, look out for incontinence, fever, saddle parasthesia.
Tx: Drug therapy vs. Nerve block

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18
Q

Myofascial Pain Syndrome

A

Likely has central mechanism with peripheral manifestations.
Causes: Abnormal muscle stress, poor posture, anemia, hypocalcemia, depression, other disease.
Tx: Massage therapy, PT, Muscle relaxants, anti-convulsants, anti-depressants.

19
Q

Tension-type Headaches (TTH)

A

Most common type of headache. Accounts for 90% of all headaches.
Causes: Sleep deprivation, stress, eyestrain, muscle tension around neck/head.

20
Q

Infrequent episodic TTH

A

Less than 1 day/month

21
Q

Frequent episodic TTH

A

1-14 days/month

22
Q

Chronic TTH

A

15 or more days/month

23
Q

4 diagnostic factors for TTH

A
  1. Location of Pain is bilateral in either head or neck.
  2. The quality of the pain is steady. Pressing, tightening, and non-throbbing.
  3. The intensity of the pain is mild to moderate.
  4. There is no aggravation of the HA by normal physical activity.
24
Q

Treatment of TTH (pharmacologic)

A 
Aspirin 325 mg 1-2PO q4-6
Tylenol 325mg 1-2PO q4-6
NSAIDS:  
Ibuprofin 200, 400, 800 mg TID
Muscle relaxers: 
Valium 5mg BID
Methocarbamol (robaxin) 500mg 1-2PO q6
Anti-anxiety
Atarax (hydroxizine) 10-20mg q6
25
Q

Non-pharmacologic Treatment of TTH

A

Behavioral Health
Chiropractic
Massage Therapy
Biofeedback

26
Q

Migraine HA

A

Episodic disorder. A severe HA generally associated with N/V, light sensitivity.
4 phases:
Premonitory, Aura, HA, postdromal.
Often start mild and get worse, often bilateral, Last from hours to days.

27
Q

Triggers of Migraines

A

Skipping meals, Change in caffeine, sleep changes, wine, cheese, BCP, Menstruation

28
Q

Tx for Migraine

A

1st line: ASA, Tylenol, NSAIDS, Indomethacin
2nd Line:
Zomig 1.25-2.5mg q2
Rizatriptan 5-10mg q2
Sumatriptan 4-6mg SC (SubQ), may repeat in 1 hr.
N/V: Phenergan, Zofran
Preventative: Tricyclic Antidepressants, Beta Blockers, Ca channel blockers

29
Q

Cluster HA

A
  • Primarily affects middle-aged men. May relate to a vascular HA disorder.
  • Repetitive HA occurring regularly for weeks to months.
  • 1-2 attacks per day for 6-12 weeks, then 6-12 months free.
  • 80% occur at night.
30
Q

4 Triggers for cluster HA

A
  1. ETOH
  2. Stress
  3. Glare
  4. Foods
31
Q

Manifestations of cluster HA

A
  1. Unilateral pain beginning around eye or temple
  2. Begins quickly, max intensity in minutes
  3. Deep ‘ice pick’ pain
  4. Ipsilateral Lacrimation, redness, congestion, N/V
  5. Pain lasts 15 mins to 3 hrs
32
Q

Mgmt of Cluster HA

A

Acute Tx: O2, Triptans (sumatriptan SQ or IN)
Growth Hormone Antagonist: Octreotide (sandostatin)
Prophylactic: Verapamil, prednisone, lithium, ergotamine, indomethacin

33
Q

TMJ Syndrome

A

Usually fairly consistent pain typically seen in young women, related to nocturnal bruxism and teeth clenching.

34
Q

TMJ manifestation

A
  1. Unilateral pain in muscles of mastication
  2. Pain can radiate to ear, cervical and jaw region.
  3. Dull ache worsened by chewing
  4. Audible clicking or crepitus
  5. Sometimes presents as HA
  6. Watch out for locking.
35
Q

TMJ Mgmt

A
  1. Muscle relaxants, NSAIDS, antidepressants, local anesthesia, botulinum injection.
  2. Jaw exercises, bite block, dental care, avoid stimulants.
36
Q

Post-herpetic neuralgia (PHN)

A

Nerves involved with infection of acute herpes are inflamed. Lies dormant until initiating event.

  • thoracic, trigeminal and cervical sites most common
  • sharp, burning stabbing
  • have areas of anesthesia
  • impaired sleep, anorexia
37
Q

PHN Mgmt

A

Herpes Zoster Vaccine

  • tramadol, gabapentin, carbamazepine, TCA’s.
  • nerve blocks
38
Q

Trigeminal Neuralgia

A
  • Usually compression of nerve root by loop of artery or vein.
  • Compression leads to demyelination
  • More frequent in middle or later life
39
Q

Trigeminal Neuralgia Manifestation

A
  1. Unilateral sudden facial pain near ear shooting
  2. Asymptomatic at night
  3. Triggered by light stimulus
  4. Progresses so episodes become more common
  5. Normal neuro exam.
40
Q

Trigeminal Neuralgia Mgmt

A
  1. MRI should be done for some cases to rule out disease.

2. Medications or surgery

41
Q

CRPS

A

Complex Regional Pain Syndrome

42
Q

Stages of CRPS

A
  1. Development of pain in limb. burning, throbbing, sensitive to touch, cold, localized edema.
  2. Progression of edema, thickening of skin, muscle wasting, brawny skin, lasts 3-6 months.
  3. Limitation of mvmt, contracture of digits, waxy trophic skin changes, brittle ridged nails.
43
Q

Tx of CRPS

A

PT, anti-depressants, prednisone, regional nerve blocks.

Pain (4 decks)

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