Intro to spinal pain/Degenerative spinal conditions Flashcards
What is spinal pain defined as?
An unpleasant sensory + emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
What are the three basic types of pain as described by the IASP?
Nociceptive
Neuropathic
Nociplastic
What is nociceptive pain (somatic pain)? (in general)
“Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors”
- acute
- lasts less than 3 months
- sprains/strains
What is neuropathic pain?
“Pain caused by a lesion or disease of the somatosensory nervous system”
What is peripheral neuropathic pain?
Pain caused by a lesion or disease of the peripheral somatosensory nervous system
e.g. diabetic neuropathy, spinal nerve root compression with inflammation
What is central neuropathic pain?
Pain caused by a lesion or disease of the central somatosensory system
e.g. stroke, parkinsons or MS
What is nociplastic pain?
“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”
- type of chronic pain caused by abnormal processing in the CNS - idiopathic
- Central sensitisation is a major underlying mechanism of neoplastic pain
- ‘diffuse’ pain, hypersensitivity + allodyniaa
Souces of spinal pain?
- IV disc
- Facet joint structures
- Ligaments + muscles
- Spinal nerve roots
- Sacroiliac joint structures
- Referral from other organs e.g. prostate
Main types of spinal pain?
- Nociceptive (somatic) pain
- Nociceptive (somatic) referred pain
- Radicular pain (type of peripheral neurogenic pain)
- Nociplastic pain (linked to central sensitisation)
What is nociceptive (somatic) pain?
Pain that is evoked by noxious stimulation of structures in the spine.
- Any msk spinal structure with a sensory nerve supply can potentially be a source of somatic pain
e.g. ligaments, muscles, discs
Can be sub-categorised:
→ mechanical
→ inflammotry
→ ischaemic
What is nociceptive referred spinal pain?
Noxious stimulation of the structures in the spine can produce referred pain in addition to local spinal pain.
- tissue damage in one location is felt as PAIN in another area
Clinical features of nociceptive referred pain?
- deep, diffuse ache
- non-dermatomal distribution (+no neuro signs)
- can refer distally
→lumbar spine referred pain is commonly over the buttock + thigh area but may refer further distally
→ cervical spine referred pain may be distributed in the neck, thorax, upper limb or head
What is the source of pain for radicular pain?
Dorsal nerve roots or the dorsal root ganglion.
Clinical features of radicular pain?
- severe, ‘sickening’, ‘burning’, ‘lacinating’, ‘electric’ type of pains
- DERMATOMAL DISTRIBUTION
- often have worse pain distally
- may be latent/or highly irritable
- unlikely to cause local spine pain
When does radiciulopathy occur?
Occurs when nerve conduction in a spinal nerve or its roots is blocked.
Neurological signs + symptoms.
Sensory fibres: paresthesia (burning prickling sensation) or anaesthesia (numbness) - dermatomal
Motor fibres: muscle weakness - myotomal
What is important to note about radiculopathy and radicular pain?
Radiculopathy and radicular pain often present together, but can each present without the other.
What is central sensitisation?
Increased responsiveness of nociceptive neurones in the CNS to their normal or subthreshold afferent input.
How does central sensitisation develop?
Can develop as part of any pain condition as a result of continued afferent input (nociceptive or neuropathic)
Reg flags for the spine?
→ <20 or >55
→ constant progressive pain - e.g spinal tumour
→ violent trauma
→ previous history of cancer
→ unexplained weight loss
→ systemic steroid use - osteoporosis risk
→ IV drug use/HIV
→ structural deformity e.g. kyphosis or scoliosis
→ (night pain> daytime pain)
Red flags for cauda equina?
- sphincter disturbance
- saddle anaesthesia
- sexual dysfunction
- widespread neurological signs
- gait disturbance
These signs and symptoms may suggest cauda equina syndrome and require urgent and immediate investigation.
(may suggest other neurological conditions)
What is important to note about the annulus fibrosus?
It has concentrically arranged lamellae with an oblique alternating arrangement of collagen fibres.
This means it can withstand shearing and torsional forces.
How many patients have non-specific spinal pain and what kind of pain does this indicate?
90% of patients
Mostly mechanical spine problems. Likely to have nociceptive or ncociceptive referred pain, if chronic may also have central sensitisation and nociplastic pain
What is spondylosis?
Degenerative changes of the central intervertebral joints.
Occurs in normal aging but can occur more quickly in some individuals that others.
Aetiology of spondylosis?
- cellular senescence - biological aging
- alteration in disc nutrition
- genetic factors
- mechanical stress + repeated injury
- smoking
