Comfort & Chronic Fatigue Syndrome

Question 1

What is the most common symptom that makes a person seek medical attention?

Answer 1

Pain.

Question 2

Pain is always?

Answer 2

Subjective.

Question 3

Most reliable indicator of pain?

Answer 3

The patient’s self report of pain.

A clinician needs to accept and respect this self-report, absent clear reasons for doubt.

Question 4

Pain without an identifiable cause should not be routinely attributed to?

Answer 4

Psychological causes. A uniform pain threshold does not exist. Pain can exist when no physical cause can be found.

Question 5

Pain tolerance varies depending on?

Answer 5

• Heredity
• Energy level
• Coping Skills
• Prior experiences with pain
• Patients with chronic pain may be more sensitive to pain and other stimuli

Question 6

• What are the mechanisms of pain?

Answer 6

1. Trandsduction
2. Transmission
3. Perception
4. Modulation

Question 7

• What is transduction?

Answer 7

Involves nerve fibers that react to thermal, chemical, and mechanical stimuli.

Question 8

• What is transmission?

Answer 8

• After nerve fibers are activated, the information is transmitted to the central nervous system.
• The dorsal root of the spinal cord receives, transmits, and processes sensory impulses.

Question 9

• What is perception?

Answer 9

Afferent nerve fibers within the dorsal room then transmit the impulses through the brainstem and thalamus, to the cortex of the brain, where the experience of pain is perceived.

Question 10

Where is pain perceived?

Answer 10

In the cortex of the brain.

Question 11

• What is modulation?

Answer 11

• Process of altering the stimuli by either inhibiting or facilitating nociceptive signals.
• Modulation of the pain signals occur at the peripheral, spinal cord, and brain levels.

Question 12

What is pain threshold?

Answer 12

Lowest intensity of painful stimuli that the patient perceives as pain.

Question 13

How does a patient’s threshold vary?

Answer 13

Depends on psychological factors, but is essentially the same for all people who have intact central and peripheral nervous system.

Question 14

What is pain tolerance?

Answer 14

Different for each patient. Some patients tolerate high levels of pain with little distress and others have distress at low levels.

Question 15

Affecting factors of pain tolerance?

Answer 15

• Family
• Occupational roles
• Spiritual beliefs
• Culture
• Sexual identity/stereotypes
• Communication skills
• Stage of growth and development
• Personality
• Fear and anxiety

Question 16

Principles of pain management?

Answer 16

• Establish a therapeutic relationship.
• Alleviate anxiety.
• Provide distraction or diversion.
• Anticipate fears.
• Provide physical care.
  • Non-pharmalogical and pharmalogical.
  • Anticipate pain (post-op ambulation).
  • Repositioning/positioning patient).

Question 17

Assessment of pain consists of?

Answer 17

1. Location
   - - Where is the pain?
2. Onset & Pattern
   - - When did it start?
   - - Was it sudden or develop overtime?
   - - Is it continuous or intermittent?
3. Extension or Radiation
   - - Does the pain move to other areas?
4. Duration
   - - How long does the pain last?
5. Character or Quality
   - - Describe your pain to me, sharp, dull, shooting, aching?
6. Precipitating, aggravating and alleviating factors.
   - - What starts the pain?
   - - What makes it worse?
   - - What makes it better?
7. Associated Manifestations
   - - Anorexia
   - - Nausea
   - - Restlessness
   - - Insomnia
8. Effects on ADLs
   - - Sleep
   - - Appetite
   - - Concentration
   - - Work/school
   - - Relationships
   - - Activities
   - - Emotional State

Question 18

How do you know if a person has CFS?

Answer 18

• 6 or more consecutive months
• Fatigue is not due to ongoing exertion or other medical conditions associated with fatigue.
• The fatigue significantly interferes with daily activities and work.

Question 19

Medical conditions associated with fatigue?

Answer 19

Must be ruled out by a doctor after diagnostic tests have been conducted to diagnose person with CFS.

Question 20

What does CFS stand for?

Answer 20

Chronic Fatigue Syndrome.

Question 21

• How many symptoms do you need to be diagnosed with CFS?

Answer 21

4 out of 8.

Question 22

• What are the signs and symptoms of CFS?

Answer 22

1. Post exertion malaise > 24 hours
2. Unrefreshing sleep
3. Significant impairment of short-term memory or concentration
4. Muscle pain
5. Pain in the joints without swelling or redness
6. Headaches of a new type, pattern, or severity
7. Tender lymph nodes in the neck or armpit
8. A sore throat that is frequent or recurring

Question 23

What causes CFS?

Answer 23

Unknown.

Question 24

• What are the triggers that may cause CFS?

Answer 24

1. Infections
2. Immune disorders: Myalgic encephalitis and immune dysfunction go together. Cytokines cause immune system changes.
3. Stress
4. Trauma
5. Toxins

Question 25

* Stress or infection causing CFS?

Answer 25

CFS may be caused by stress or a viral infection, which may lead to chronic production of cytokines (inflammatory mediators) and then to CFS?

Question 26

What are cytokines?

Answer 26

Inflammatory mediators. Immune System -> Lymphoid Organs -> T Cells -> Cytokines -> Immunological Changes -> Cutaneous energy, Markers of immune activation.

Question 27

What causes adrenal insufficiency?

Answer 27

Physical or emotional stress, alters the activity of the hypothalamic-pituitary adrenal axis, or HPA axis, leading to altered release of corticotrophin-releasing hormone (CRH), cortisol, and other hormones. These hormones can influence the immune system and many other body systems.

Question 28

Commonly reported pre-onset condition in CFS patients?

Answer 28

Physical or emotional stress.

Question 29

NDX for CFS?

Answer 29

Fatigue due to sleep problems.

Question 30

Treatment for CFS?

Answer 30

1. Establish a regular bedtime routine. 2. Avoid napping during the day. 3. Incorporate an extended wind down period. 4. Use the bed only for sleep and sex. 5. Schedule regular sleep and wake times. 6. Control noise, light, and temperature. 7. Avoid alcohol, caffeine, and tobacco.