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Pain Medicine > Just the Facts Randoms > Flashcards

Just the Facts Randoms Flashcards

1
Q

What are modifiable factors associated with chronic pain?

A
  • pain
  • mental health issues (depression and anxiety)
  • other chronic disease (CAD, COPD)
  • smoking
  • obesity
  • sleep disturbance
  • employment status and occupational risk factors
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2
Q

What are non-modifiable factors associated with chronic pain?

A
  • older age
  • female gender
  • low SES
  • high risk surgeries (surgery >3hrs)
  • severe post-op pain
  • history of abuse or violence
  • family history fo chronic pain
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3
Q

What types of bias are there in chronic pain studies?

A
  • response bias (subjects want to please research by answering positively)
  • selection bias (patients with differences in the same group)
  • co-intervention bias (receiving other beneficial treatments during the study)
  • attrition bias (patients who are not benefitting dropout of study)
  • publication bias (+ studies published and - ones not)
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4
Q

Taxonomy:

  1. analgesia
  2. anesthesia dolorosa
  3. dysesthesia
  4. hyperesthesia
  5. hyperpathia
A
  1. Analgesia - absence of pain in response to a stimulus that usually causes pain.
  2. Anesthesia dolorosa - pain in an area or region which is anesthetic
  3. Dysesthesia - an unpleasant abnormal sensation, whether spontaneous or evoked
  4. Hyperesthesia - increased sensitivity to stimulation, excluding the special senses
  5. Hyperpathia - a painful syndrome characterized by increased reaction to a stimulus (especially a repetitive stimulus) as well as an increased threshold.
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5
Q

Taxonomy:

  1. Hypoesthesia -
  2. neuralgia -
  3. neuropathic pain
  4. Neuropathy
  5. nociceptor
A
  1. Hypoesthesia - increased sensitivity to stimulation, excluding the special senses
  2. Neuralgia - Pain in the distribution of a nerve or nerves
  3. Neuropathic pain - pain caused by a lesion or disease of the somatosensory nervous system
  4. Neuropathy - disturbance in function or pathological change in a nerve; 1 nerve - mononeuropathy; in several - mononeuropathy multiplex; if diffuse and bilateral - polyneuropathy
  5. Nociceptor - a sensory receptor of the PNS that encodes noxious stimuli
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6
Q

Taxonomy:

  1. Nociceptive pain
  2. Noxious stimuli
  3. Pain tolerance level
  4. Sensitization
A
  1. Nociceptive pain - pain resulting from damage to non-neuronal tissue
  2. Noxious stimuli - a stimulus that is damaging or threatens damage to normal tissue
  3. Pain tolerance level - maximum intensity of a pain-producing stimulus that a subject is willing to tolerate in a given environment
  4. Sensitization - increased responsiveness of nociceptive neurons to their normal input and/or recruitment of a response to normally sub-threshold inputs.
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7
Q

What are the four tenants of medical ethics?

A
  • beneficence
  • non-maleficence
  • respect for autonomy
  • justice
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8
Q

What are the 5 components of the psychosocial screening ACT-UP?

A

Activites - how is pain affecting your life? (sleep, physical activities, etc.)
Coping
Think - do you think your pain will get better?
Upset - have you been feeling worried or upset?
People - how do people respond when you have pain?

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9
Q

Name 5 psychological measures?

A
  • Beck Depression inventory - (0-13 - mild; 14-19 - moderate; 20-28 moderately severe; 29-63 severe depression)
  • PHQ9 - (0-5 - mild; 6-10 - moderate; 11-15 moderately severe; 16-20 severe depression)
  • GAD-7 (5 - mild; 10 - moderate; 15 severe anxiety)
  • Pain Catastrophization Scale (cut-off >30)
  • Coping Strategies Questionnaire
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10
Q

Name 3 unidimensional pain measures

A
  • VAS
  • NRS
  • VRS
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11
Q

Pain quality and location measure?

A

Short-form McGill Pain Questionnaire

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12
Q

3 Pain interference and function measure; general?

A
  • Pain disability index
  • Brief pain index
  • PROMIS Pain Interference and Pain Behaviors item banks
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13
Q

2 Pain interference and function measure; specific?

A
  • Western Ontario McMaster Osteoarthritis Index (WOMAC)

- Roland-Morris Disability Questionnaire (for back pain)

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14
Q

2 HRQOL measure?

A
  • Medical Outcomes Study Short-from Health Survey

- West Haven-Yale Multidimensional Pain Inventory

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15
Q

Indications for EMG?

A
  • suspected nerve entrapments or other mononeuropathies
  • suspected polyneuropathies
  • suspected radiculopathy or plexopathy
  • suspected NMJ disease
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16
Q

Contraindications/cautions to EMG?

A
  • avoid stimulation near a pacemaker, AICD, SCS, intrathecal pump
  • marked edema, morbid obesity and skin damage may impede stimulation and signal pick up
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17
Q

What clinical scenarios are there increased/decreased amplitude?

A

Decreased amplitude - myopathy, axonal neuropathy, motor neuron disease
Increased amplitude - Reinnervation after injury, spatially larger motor units, hypertrophied muscle fibers

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18
Q

What clinical scenarios are there increased/decreased duration?

A

Decreased - loss or atrophy of muscle tissue

Increased - Reinnervation after injury, spatially dispersed motor units

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19
Q

What clinical scenarios are there increased/decreased number of phases?

A

Decreased - not seen

Increased - myopathy and neuropathy

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20
Q

What clinical scenarios are there increased/decreased number of recruitment?

A

Decreased - muscle denervation (neuropathic process)

Increased - muscle damage (myopathic process)

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21
Q

What clinical scenarios are there increased/decreased number of spontaneous activity?

A

Decreased - not seen

Increased - myopathy, neuropathy or direct trauma

22
Q

Name 3 opioid risk tools

A
  • Opioid risk tool
  • SOAPP - Screener and Opioid Assessment for Patients with Pain
  • COMM - Common Opioid Misuse Measure
23
Q 
Common analgesic CYP substrates?
1A2
2B6
2C9
2C19
2D6
3A4
A

1A2 - amitriptyline, desipramine, tizanidine, acetaminophen, cyclobenzaprine, duloxetine, lidocaine
2B6 - methadone, ketamine
2C9 - celecoxib, ibuprofen
2C19 - topirimate, amitriptyline
2D6- codeine, tramadol, oxycodone, hydrocodone, amitriptyline, nortriptyline, duloxetine, venlafaxine
3A4 - methadone, fentanyl, buprenorphine

24
Q

Opioids undergo Phase I metabolism by ____ and ____ ad phase II metabolism by ____

A
  • 3A4
  • 2D6
  • glucuronidation
25
Q

Which benzodiazepine cannot be picked up by UDS immunoassay?

A
  • clonazepam
26
Q

Give the time frames in which the substances below can be detected in UDS?

  1. lorazepam
  2. diazepam
  3. cocaine
  4. buprenorphine
  5. methadone
  6. Most opioids
A
  1. lorazepam - 3 days
  2. diazepam - 30 days
  3. cocaine - 2-4 days
  4. buprenorphine <11 days
  5. methadone <14 days
  6. Most opioids 2-4 days
27
Q

Name three medications that can cause a false positive for cannabinoids on UDS?

A
  • ibuprofen
  • ketoprofen
  • naproxen
  • pantoprozole
  • dronabinol
28
Q

Name three medications that can cause a false positive for opioids on UDS?

A
  • poppy seeds
  • dextromethorphan
  • diphenhydramine
  • rifampin
  • burprenorphine
  • quinine
29
Q

Match the opioid below with its active pharmaceutical metabolite:

  1. morphine
  2. heroin
  3. Codeine
  4. oxycodone
A
  1. hydromorphone
  2. morphine
  3. morphine, hydrocodone
  4. oxymorphone
30
Q

Name 8 predictors for LBP:

A
  1. poor physical fitness and comorbidity
  2. low SES
  3. age > 55
  4. obesity
  5. dimensions of spinal canal
  6. smoking
  7. substance use history
  8. hard physical labour
31
Q

Name 8 predictors of LBP-related chronicity and disability:

A
  1. radicular leg pain
  2. poor self-rated health status
  3. positive SLR
  4. reduced flexibility of L-spine
  5. poor coping strategies
  6. high levels of distress, depression and somatization
  7. low activity levels
  8. anxiety
32
Q

DDx of LBP is classified into what 3 major categories?

A
  1. Mechanical
  2. Non-mechanical
  3. Visceral
33
Q

Name 10 major diagnostic categories for mechanical low back pain?

A
  1. Lumbar strain or sprain
  2. Hyperplasia
  3. Spondylosis
  4. Spondylolithesis
  5. Herniated disk
  6. Spinal stenosis
  7. osteoporosis with compression #
  8. Fractures
  9. Congenital disease
  10. Pagets Disease
34
Q

Name major diagnostic categories for non-mechanical low back pain?

A
  1. Neoplasia
    - metastatic disease
    - multiple myeloma
    - SC tumors
    - retroperitoneal tumors
  2. Infections
    - OM
    - septic discitis
    - spinal abcesses
  3. Inflammatory Arthritis
    - Ank spod
    - Reiter syndrome
    - psoriatic spondylitis
    - IBD
    - PMR
35
Q

Name major diagnostic categories for visceral low back pain?

A
  1. Pelvic organs
    - prostatitis
    - endometriosis
    - chronic PID
  2. Renal disease
    - pyelo
    - renal stones
  3. Vascular
    - AAA
    - Aortoiliac disease
  4. GI
    - pacreatitis
    - cholecystitis
    - perfed bowel
36
Q

Anterior structures that cause LBP?

A

discs
vertebral bodies
ligaments
muscles

37
Q

Midline structures that cause LBP?

A

Spinal cord

nerve roots

38
Q

Posterior structures that cause LBP?

A

Facet joints
ligaments
SI joints
paraspinal muscles

39
Q 
On the LBP physical exam name the muscles, sensory and DTR findings with:
L2
L3
L4
L5 
S1
A

L2 - iliopsoas; ant thigh/groin; none
L3 - quadriceps; ant/lateral thigh; patellar
L4 - quads; medial ankle/foot; patellar
L5 - ankle dorsiflexion, EHL; dorsum of foot; none
S1 - gastroc; lateral plantar foot; achilles

40
Q

CT myelogram is indicated for work up of LBP in what two situations? Also this is the most sensitive test for what condition?

A
  1. contraindication to MRI
  2. spinal instrumentation
    * spinal nerve compression
41
Q

What are the indications for surgical management of LBP?

A
  • nerve root compression
  • incapacitating pain
  • progressive neurological deficit
  • cauda equina syndrome
  • infection or neoplasm
42
Q

Etiologies of neck pain and prevalence in pain clinics?

A
  • facet joint - 55%
  • disc pain - 16%
  • AA joint pain 9%
43
Q

C-spine RF side effects?

A
  • vasovagal syncope
  • dermoid cyst
  • neuritis
  • numbness in cutaneous territory 29%
  • dysesthesias 19%
  • RF to TON - numbness (97%), ataxia (95%), dysesthesias (55%), hypersensitivity (15%), and itch (10%)
44
Q

What are the three afferents that mediate the perception of abdominal pain?

A
  • Visceral splanchnic
  • Somatic/parietal
  • Referred pathway
45
Q

Dual afferent innervations to the abdominal viscera?

A

each region is innervated by two afferent nerves

  • esophagus to proximal colon - the vagus nerves and the thoracolumbar spinal afferents
  • from distal colon to the rectum - innervated by sacrospinal afferents (pelvic and rectal nerves) and thoracolumbar via splachnic nerves
46
Q

Ascending tracts that transmit nociception from abdominal viscera?

A
  • spinoreticular tract - unconscious pain perception and emotional effects
  • spinomesencephalic tract - unconscious pain perception and emotional effects
  • spinothalamic tract - conscious preception of pain
47
Q

Two most common causes of acute pancreatitis?

A
  • cholecysitis

- alcohol abuse

48
Q

What are the set of evaluative tools or principle proposed in 1999 by Krames for chronic pain management?

A
  • Safe
  • Appropriateness
  • Fiscal Neutrality
  • Effectiveness
49
Q

What three pathways converge to result in the phenomenon of referred pain?

A
  • spinoreticular
  • spinothalamic
  • dorsal column
50
Q

What are the criteria for functional abdominal pain criteria childhood (Rome III)?

A
  • no evidence of anatomic, neoplastic, inflammatory or metabolic pathology
  • episodic or continuous pain
  • does not meet criteria for other functional abdominal pain
    To meet diagnosis for syndrome
    Above + 25% of the time one of:
  • loss of function
  • somatic symptoms (headache, limb pain, insomnia, etc.)
  • once per week for >2 months
51
Q

What are the criteria for functional abdominal pain criteria for adults (Rome III)?

A
  • continuous or nearly continuous pain
  • does not meet criteria for other functional GI disorder
  • some loss of daily function
  • not or only occasionally associated with physiological events - eating, BMs or menses
  • pain is not feigned

Pain Medicine (14 decks)

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