Just the Facts Randoms Flashcards
What are modifiable factors associated with chronic pain?
- pain
- mental health issues (depression and anxiety)
- other chronic disease (CAD, COPD)
- smoking
- obesity
- sleep disturbance
- employment status and occupational risk factors
What are non-modifiable factors associated with chronic pain?
- 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
What types of bias are there in chronic pain studies?
- 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)
Taxonomy:
- analgesia
- anesthesia dolorosa
- dysesthesia
- hyperesthesia
- hyperpathia
- Analgesia - absence of pain in response to a stimulus that usually causes pain.
- Anesthesia dolorosa - pain in an area or region which is anesthetic
- Dysesthesia - an unpleasant abnormal sensation, whether spontaneous or evoked
- Hyperesthesia - increased sensitivity to stimulation, excluding the special senses
- Hyperpathia - a painful syndrome characterized by increased reaction to a stimulus (especially a repetitive stimulus) as well as an increased threshold.
Taxonomy:
- Hypoesthesia -
- neuralgia -
- neuropathic pain
- Neuropathy
- nociceptor
- Hypoesthesia - increased sensitivity to stimulation, excluding the special senses
- Neuralgia - Pain in the distribution of a nerve or nerves
- Neuropathic pain - pain caused by a lesion or disease of the somatosensory nervous system
- Neuropathy - disturbance in function or pathological change in a nerve; 1 nerve - mononeuropathy; in several - mononeuropathy multiplex; if diffuse and bilateral - polyneuropathy
- Nociceptor - a sensory receptor of the PNS that encodes noxious stimuli
Taxonomy:
- Nociceptive pain
- Noxious stimuli
- Pain tolerance level
- Sensitization
- Nociceptive pain - pain resulting from damage to non-neuronal tissue
- Noxious stimuli - a stimulus that is damaging or threatens damage to normal tissue
- Pain tolerance level - maximum intensity of a pain-producing stimulus that a subject is willing to tolerate in a given environment
- Sensitization - increased responsiveness of nociceptive neurons to their normal input and/or recruitment of a response to normally sub-threshold inputs.
What are the four tenants of medical ethics?
- beneficence
- non-maleficence
- respect for autonomy
- justice
What are the 5 components of the psychosocial screening ACT-UP?
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?
Name 5 psychological measures?
- 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
Name 3 unidimensional pain measures
- VAS
- NRS
- VRS
Pain quality and location measure?
Short-form McGill Pain Questionnaire
3 Pain interference and function measure; general?
- Pain disability index
- Brief pain index
- PROMIS Pain Interference and Pain Behaviors item banks
2 Pain interference and function measure; specific?
- Western Ontario McMaster Osteoarthritis Index (WOMAC)
- Roland-Morris Disability Questionnaire (for back pain)
2 HRQOL measure?
- Medical Outcomes Study Short-from Health Survey
- West Haven-Yale Multidimensional Pain Inventory
Indications for EMG?
- suspected nerve entrapments or other mononeuropathies
- suspected polyneuropathies
- suspected radiculopathy or plexopathy
- suspected NMJ disease
Contraindications/cautions to EMG?
- avoid stimulation near a pacemaker, AICD, SCS, intrathecal pump
- marked edema, morbid obesity and skin damage may impede stimulation and signal pick up
What clinical scenarios are there increased/decreased amplitude?
Decreased amplitude - myopathy, axonal neuropathy, motor neuron disease
Increased amplitude - Reinnervation after injury, spatially larger motor units, hypertrophied muscle fibers
What clinical scenarios are there increased/decreased duration?
Decreased - loss or atrophy of muscle tissue
Increased - Reinnervation after injury, spatially dispersed motor units
What clinical scenarios are there increased/decreased number of phases?
Decreased - not seen
Increased - myopathy and neuropathy
What clinical scenarios are there increased/decreased number of recruitment?
Decreased - muscle denervation (neuropathic process)
Increased - muscle damage (myopathic process)
What clinical scenarios are there increased/decreased number of spontaneous activity?
Decreased - not seen
Increased - myopathy, neuropathy or direct trauma
Name 3 opioid risk tools
- Opioid risk tool
- SOAPP - Screener and Opioid Assessment for Patients with Pain
- COMM - Common Opioid Misuse Measure
Common analgesic CYP substrates? 1A2 2B6 2C9 2C19 2D6 3A4
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
Opioids undergo Phase I metabolism by ____ and ____ ad phase II metabolism by ____
- 3A4
- 2D6
- glucuronidation
Which benzodiazepine cannot be picked up by UDS immunoassay?
- clonazepam
Give the time frames in which the substances below can be detected in UDS?
- lorazepam
- diazepam
- cocaine
- buprenorphine
- methadone
- Most opioids
- lorazepam - 3 days
- diazepam - 30 days
- cocaine - 2-4 days
- buprenorphine <11 days
- methadone <14 days
- Most opioids 2-4 days
Name three medications that can cause a false positive for cannabinoids on UDS?
- ibuprofen
- ketoprofen
- naproxen
- pantoprozole
- dronabinol
Name three medications that can cause a false positive for opioids on UDS?
- poppy seeds
- dextromethorphan
- diphenhydramine
- rifampin
- burprenorphine
- quinine
Match the opioid below with its active pharmaceutical metabolite:
- morphine
- heroin
- Codeine
- oxycodone
- hydromorphone
- morphine
- morphine, hydrocodone
- oxymorphone
Name 8 predictors for LBP:
- poor physical fitness and comorbidity
- low SES
- age > 55
- obesity
- dimensions of spinal canal
- smoking
- substance use history
- hard physical labour
Name 8 predictors of LBP-related chronicity and disability:
- radicular leg pain
- poor self-rated health status
- positive SLR
- reduced flexibility of L-spine
- poor coping strategies
- high levels of distress, depression and somatization
- low activity levels
- anxiety
DDx of LBP is classified into what 3 major categories?
- Mechanical
- Non-mechanical
- Visceral
Name 10 major diagnostic categories for mechanical low back pain?
- Lumbar strain or sprain
- Hyperplasia
- Spondylosis
- Spondylolithesis
- Herniated disk
- Spinal stenosis
- osteoporosis with compression #
- Fractures
- Congenital disease
- Pagets Disease
Name major diagnostic categories for non-mechanical low back pain?
- Neoplasia
- metastatic disease
- multiple myeloma
- SC tumors
- retroperitoneal tumors - Infections
- OM
- septic discitis
- spinal abcesses - Inflammatory Arthritis
- Ank spod
- Reiter syndrome
- psoriatic spondylitis
- IBD
- PMR
Name major diagnostic categories for visceral low back pain?
- Pelvic organs
- prostatitis
- endometriosis
- chronic PID - Renal disease
- pyelo
- renal stones - Vascular
- AAA
- Aortoiliac disease - GI
- pacreatitis
- cholecystitis
- perfed bowel
Anterior structures that cause LBP?
discs
vertebral bodies
ligaments
muscles
Midline structures that cause LBP?
Spinal cord
nerve roots
Posterior structures that cause LBP?
Facet joints
ligaments
SI joints
paraspinal muscles
On the LBP physical exam name the muscles, sensory and DTR findings with: L2 L3 L4 L5 S1
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
CT myelogram is indicated for work up of LBP in what two situations? Also this is the most sensitive test for what condition?
- contraindication to MRI
- spinal instrumentation
* spinal nerve compression
What are the indications for surgical management of LBP?
- nerve root compression
- incapacitating pain
- progressive neurological deficit
- cauda equina syndrome
- infection or neoplasm
Etiologies of neck pain and prevalence in pain clinics?
- facet joint - 55%
- disc pain - 16%
- AA joint pain 9%
C-spine RF side effects?
- 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%)
What are the three afferents that mediate the perception of abdominal pain?
- Visceral splanchnic
- Somatic/parietal
- Referred pathway
Dual afferent innervations to the abdominal viscera?
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
Ascending tracts that transmit nociception from abdominal viscera?
- spinoreticular tract - unconscious pain perception and emotional effects
- spinomesencephalic tract - unconscious pain perception and emotional effects
- spinothalamic tract - conscious preception of pain
Two most common causes of acute pancreatitis?
- cholecysitis
- alcohol abuse
What are the set of evaluative tools or principle proposed in 1999 by Krames for chronic pain management?
- Safe
- Appropriateness
- Fiscal Neutrality
- Effectiveness
What three pathways converge to result in the phenomenon of referred pain?
- spinoreticular
- spinothalamic
- dorsal column
What are the criteria for functional abdominal pain criteria childhood (Rome III)?
- 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
What are the criteria for functional abdominal pain criteria for adults (Rome III)?
- 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
