Lecture 04- Pain And Pain Patterns Flashcards
What are the 4 principles of referred pain?
- Pain is referred segmentally. (Due to overlap of dermatomes, most of the time symptoms will be in the “distal” end of the dermatome)
- Pain is typically referred distally. (Proximal structures will refer further than a distal structure and it may follow dermatomes pattern of the nerve root that innervates the injured tissue).
- Referred pain never crosses the midline.
- The extend of the referral is controlled by:
- the size of the dermatome and the location of the tissue at fault
- the strength of the stimulus
- the depth of the structure
The following are common descriptions of which type of pain:
- disturbs sleep
- deep aching or throbbing
- reducing by pressure
- constant waves of pain
- spasm
- mechanical stress does not aggravate
- fails PT
- aching
- squeezing
- gnawing
- burning
- cramping
- sharp
Systemic (complex)
What might pain management look like for chronic pain?
- low evidence for exercise
- low evidence for behavioral therapy
- moderate evidence for multidisciplinary approach
The following are common descriptions of which type of pain:
- throbbing
- pounding
- pulsating
Vascular 5 P’s of Vascular Disease 1. Pain 2. Pallor 3. Pulselessness 4. Paresthesia 5. Paralysis
The following are common descriptions of which type of pain:
- lancinating
- shocking
- electric
- burning
Neurological
The following are descriptions of which type of pain:
- lessens at night
- sharp or superficial (ache)
- continuous or intermittent
- mechanical stress aggravates
- sharp
- dull
- ache
- stabbing
- cramping
- deep
- sore
- heavy
MSK
What are the 5 parts of the biopsychosocial model of pain?
- Nociceptors
- Pain
- Pain Appraisal
- Pain behaviors
- Social roles for pain and illness
Which type of somatic pain is described by the following:
- associated with deep structures of the body (deep muscles and tendons, bones, deep fascia, joint capsules)
- these structures are generally irritated with visceral movement
- can be deep and aching (similar to visceral symptomology)
- dissimilar to visceral symptomology in that it will generally have a mechanical behavior of symptoms (mode)
Deep Somatic Pain
The following describes which: acute or chronic pain? Activation of nociceptors -external -internal Cell destruction -histamine, bradykinin, potassium ions, substance P, etc. (directly stimulate nociceptors) -prostaglandins (increase sensitivity) Hyperesthesia and hyperalgesia
Acute pain
Which source of pain is described by the following:
- pathophysiological changes or damage to the central or peripheral nervous system
- disruptions in the transmission of afferent and efferent impulses in the periphery, spinal cord, and brain cause changes in sensory pathways and sometimes motor dysfunction
Neuropathic
Which source of pain is described by the following:
- can be superficial or deep and poorly localized (can be sharp, gnawing, aching and/or dull)
- can be associated with autonomic symptoms (sweating, nausea, and BP changes)
- labeled according to region
Somatic Pain
Which parts of the biopsychosocial model of pain are defined below?
- Detection of tissue damage and activation of peripheral nociceptors
- Recognition in the cortex of the nociceptive activation
- The emotional response to the pain => suffering is defined as the “negative affective response brought about by pain, such as depression, anxiety, or fear
- Defines as “an outward manifestation of the pain event”
- influenced by culture and other environmental factors
- includes facial expressions, avoidance of activities, refusing to move due to fear of further injury - How pain effects the pt’s life => how the social support system and the expectations on the pt will effect them
- Nociception
- Pain
- Pain Appraisal
- Pain Behaviors
- Social Roles of Pain and Illness
Which source of pain is described by the following:
- pathology originating from all body organs and viscera pleura located in the trunk and abdomen that causes nociception (lungs, digestive, urigential, endocrine, spleen, heart, abdominal vessels/abdominal aorta)
- Pain tends to be poorly localized and diffuse => gnawing, aching, and deep
Visceral
-note; visceral pain is NOT viscerosomatic pain (while visceral pain may be poorly localized and gnawing, viscerosomatic pain is local and sharp)
Which type of somatic pain is described by the following:
- related to the skin and superficial structures, localized to the skin and subcutaneous structures
- is well localized pain and the pt can point directly to the area that hurts => local sharp, aching, or stabbing
Superficial somatic pain
What are some psychological influences on pain?
- anxiety
- depression
- panic disorder
- systemic vs psychogenic (pain catastrophizing, Waddell’s sign = non-organic pain)
___ are outcomes that are used to measure pain intensity.
Numeric Rating Scales for Pain Examples include: -Visual Analog Scale (VAS) -Numeric Rating Scale (NRS) -Verbal Rating Scale
Note; the VA has poor validity for measuring changes in pain, so it is better for initial evaluation of pain vs tracking progression of pain through the POC
Which mode of nociception is caused by the following:
-high levels of pressure on nociceptors that require direct stimulation
Mechanical
- mechanical pain arises when either normal tissue is confronted with abnormal stress or abnormal tissue (usually shortened) is confronted with normal stress
- resultant pain abates quickly once the mechanical stimulus is removed (i.e, pain and pain ablation with pinching skin)
What information about pain should a PT ascertain as part of the subjective screen/history?
- location
- description of sensation
- intensity
- duration
- frequency and duration
- pattern
- aggravating and relieving factors
- associated symptoms
What is described by the following:
“The model focuses on physical processes, such as the pathology, the biochemistry and the physiology of a disease, and does not take into account the role of social factors or individual subjectivity”.
The biomedical model
- referred pain assumes that there is an underlying physiological reason for the reflected pain
- i.e, if we can localize the tissue of injury and quickly treat that region, we will be able to eliminate the pt’s pain
Which mode of nociception is described by the following:
- quality and severity changes with the depth of tissue injury, pain does not abate quickly because of chemical processes
- superficial => severe
- deep => minimal
- pt populations with altered sensation, blood flow, or decreased tissue integrity are at high risk for getting these types of injuries
Thermal
-similar pathophysiology to chemical modes of injury
What is described by the following:
If you can activate descending pain modifications, you can inhibit local nociceptive input into the CNS
Descending pain modification
- pharmacologic interventions (SSRI’s, tricyclics antidepressants, and SNRI’s)
- endogenous opioids
- meditation
- modalities
What are the 4 general modes of nociception?
- Mechanical (mechanoreceptors)
- Chemical (chemoreceptors)
- Thermal (thermoreceptors)
- Combination (clinical)
The following describes which type of pain: referring or radiating?
-General term that refers to pain behavior felt in a separate location from it’s physical cause (i.e, visceral pain causing lower back symptoms)
Referring pain
In regards to length of time, how does acute pain compare to chronic pain?
- Acute = < 3 months
- Chronic = 3-6 months
The following describes which type of pain: referring or radiating?
- general term that indicates that symptoms travel, in a direct line, from one area to another
- may affect a large area (i.e, nerve impingement at the spine)
Radiating Pain
-note; radiating pain is a type of referring pain
The following describes which type of pain: acute or chronic? Nociceptors chronic pain -continued activation of nociceptors due to disease Neuropathic chronic pain -abnormality of pain neurons Central Nervous System Changes -allodynia Psychosocial presentations
Chronic Pain
Which mode of nociception is caused by the following:
- tissue damage (cause) => physiological response => symptom presentation (mode)
- physiological response will include the release/production of bradykinins, prostaglandins, substance p inflammatory response, etc. (activation of nociceptors)
Chemical
-pain does not abate quickly, can vary in quality, but normally involves persistent aching and burning
