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Clin Med B 2 > (Enochs + some)Lecture 7: Chronic Pain > Flashcards

(Enochs + some)Lecture 7: Chronic Pain Flashcards

1
Q

Define pain.

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

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2
Q

What is the MC reason that people seek medical care?

A

Pain

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3
Q

What do most opioid OD deaths come from?

A

Heroin and fentanyl

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4
Q

What is nonmaleficence?

A

Not doing harm.

Slightly different from doing good. (Beneficence)

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5
Q

How long does acute pain usually last?

A

Momentarily to 6 months.

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6
Q

At what point is pain considered chronic?

A

3 months on average.

ASIPP defines it as 6 months.

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7
Q

What is the purpose of chronic pain?

A

No purpose :(

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8
Q

What kind of chronic pain is adaptable?

A

Constant chronic pain.

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9
Q

What happens to gray matter in patients with chronic pain?

A

Decreases.

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10
Q

When is chronic pain mostly treatable?

A

Within 2 years

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11
Q

What are the 3 NTs that excite pain?

A
  • Substance P
  • CGRP (calcitonin gene related peptide)
  • Glutamate
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12
Q

What is a nocireceptor?

A

A receptor that can differentiate between what is painful and not.

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13
Q

Describe an A-beta fiber.

A
  • Thick, myelinated, low threshold mechanoreceptors.
  • Associated with light touch, pressure, and hair movement.
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14
Q

Describe an A-delta fiber.

A
  • Thin, myelinated, high and low mechanical + thermal.
  • First, Sharp intense pain
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15
Q

Describe a C fiber.

A
  • Unmyelinated, free nerve endings.
  • High threshold to all stimuli.
  • Majority of afferent fibers
  • Prolonged, burning sensation after the A-stimulus
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16
Q

Where are the veins and arteries contained with the spinal cord?

A

Epidural space

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17
Q

Describe the pathway of pain beginning with peripheral sensory receptors.

A
  1. PEripheral sensory receptor
  2. Dorsal root ganglia
  3. Dorsal root
  4. Synapse in dorsal horn/column
  5. Connect with secondary order neurons
  6. Goes other contralateral and ascend (lateral spinothalamic)
  7. Other: ascend ipsilateral, descends, then goes to reflex arc.
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18
Q

What is the anterolateral system?

A
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19
Q

Describe white matter in the spinal cord.

A
  • Myelinated
  • Longitudinal
  • Up down
  • Signal conduction

High speed internet

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20
Q

Describe gray matter.

A
  • Segmented
  • Side to side
  • Signal processing
  • Also makes up nerve roots

Processors

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21
Q

When do spinal nerves not match the # of vertebrae?

A

Cervical; you have 8 CNs and 7 cervical vertebrae.

22
Q

What are the 3 types of pain and what is the MC?

A
  • Nociceptive (MC)
  • Neuropathic
  • Psychogenic
23
Q

What is Nociceptive pain?

A
  • Activation of A delta and C fibers.
  • Sensing dangerous/noxious things
24
Q

What falls under nociceptive pain disorders?

A
  • Arthritis
  • Gout
  • Cancer
  • Facet joint arthropathy
25
What is neuropathic pain?
* Abnormal processing in the PNS or CNS. * Burning, stabbing, or electrical sensations. * NMDA/glutamate governs it. | Methadone works on neuropathic pain bc it works on NMDA.
26
What is allodynia?
Things that don't cause pain cause pain | I.E. a bedsheet hurting you
27
What is dysthesia?
Abnormal pain "like fire"
28
What is hyperlagesia?
Hypersensitivity to a stimulus that normally isn't very painful. | Pinprick feeling like a bullet
29
What are trophic changes?
Change of skin/nail due to injury
30
What is type I complex regional pain syndrome? Type II?
1. Idiopathic or reflex sympathetic dystrophy. 2. Causalgia/normal CRPS
31
What kind of pain is opiate sensitive?
Nociceptive pain
32
What kind of pain does not worsen with position?
Neuropathic.
33
What is psychogenic pain typically associated with?
Depression
34
What questionnaire is used to evaluate the effect of pain on someone's quality of life?
Oswestry disability index
35
What is a pain agreement?
A non-legally binding document to help with patient compliance. | However, if YOU follow it, it may help with making a case.
36
What are the aspects of a pain agreement?
1. One prescriber for meds 2. Agree to UDS and any testing 3. lost/stolen meds WILL NOT be replaced 4. One pharmacy only 5. Unfilled and unused meds must be brought back 6. Insist on f/u for any med changes
37
What is the scale used to estimate pain?
Wong-baker FACES scale
38
What questionnaire can be used in place of the pain scale to monitor improvement?
Brief pain impact questionnaire
39
What are the common spinal physical exam tests?
* Straight leg raises for herniated discs * Crossed leg raises for herniated discs * Patrick's/FABER = hip joint pathology * Zygomatic joint loading = contralateral pain * Foot-drop or toe drag = L5 root compression, sciatica, cauda equina syndrome * Piriformis test = Lat Decubitus with hip flex produces pain * Spurling's * Axial compression = disc joint disease
40
What are Waddell's signs?
Nonsensical/anatomical pain from normal tests. | Producing weird pain different from expected pain.
41
What is a fake Hoover's test?
Good leg isn't fighting you when they lift their weak one.
42
What is a fake UE arm test?
Give-way weakness appears in "bad" arm, but if both are tested, both give-way.
43
What is spinal cord stimulation mainly used to treat?
Lower back pain
44
What peripheral nerves can be stimulated?
* Ilioinguinal * Somatic peripheral * Occipital * Cranial Nerves
45
What kind of stimulation type varies its waveforms and can cover a large range of pathology?
Burst stimulation
46
What part of the spinal cord is the target for stimulators?
Dorsal root ganglion
47
What does true CRPS look like?
* Hyperalgesia * Swollen, smooth, glossy appearance * Injury precipitated it * Long-lasting
48
What is the mild procedure?
Minimally invasive lumbar decopression procedure
49
When are intrathecal pain meds given?
Last resort
50
What are the common intrathecal meds?
* Morphine * Baclofen * Hydromorphone * Fentanyl * Sufetanil * Clonidine * Bupivacaine * Prialt (sea snails) * Octreotide
51
How do we begin opioid dosing?
IR dosing with 50-90 MME. ## Footnote Morphine equivalents
52

Clin Med B 2 (44 decks)

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