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Neuro > Lecture 7: Chronic Pain > Flashcards

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

d= damn that hurts

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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

C = continuous

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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 Cervical spinal nerves 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
Q

What is neuropathic pain?

A
  • 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
Q

What is allodynia?

A

Things that don’t cause pain cause pain

I.E. a bedsheet hurting you

27
Q

What is dysthesia?

A

Abnormal pain “like fire”

28
Q

What is hyperalgesia?

A

Hypersensitivity to a stimulus that normally isn’t very painful.

Pinprick feeling like a bullet

29
Q

What are trophic changes?

A

Change of skin/nail due to injury

30
Q

What is type I complex regional pain syndrome? Type II?

A
  1. Idiopathic or reflex sympathetic dystrophy.
  2. Causalgia/normal CRPS
31
Q

What kind of pain is opiate sensitive?

A

Nociceptive pain

32
Q

What kind of pain does not worsen with position?

A

Neuropathic.

33
Q

What is psychogenic pain typically associated with?

A

Depression

34
Q

What questionnaire is used to evaluate the effect of pain on someone’s quality of life?

A

Oswestry disability index

35
Q

What is a pain agreement?

A

A non-legally binding document to help with patient compliance.

However, if YOU follow it, it may help with making a case.

36
Q

What are the aspects of a pain agreement?

A
  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
Q

What is the scale used to estimate pain?

A

Wong-baker FACES scale

38
Q

What questionnaire can be used in place of the pain scale to monitor improvement?

A

Brief pain impact questionnaire

39
Q

What are the common spinal physical exam tests?

A
  • 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
Q

What are Waddell’s signs?

A

Nonsensical/anatomical pain from normal tests.

Producing weird pain different from expected pain.

waddells is weird

41
Q

What is a fake Hoover’s test?

A

Good leg isn’t fighting you when they lift their weak one.

42
Q

What is a fake UE arm test?

A

Give-way weakness appears in “bad” arm, but if both are tested, both give-way.

43
Q

What is spinal cord stimulation mainly used to treat?

A

Lower back pain

44
Q

What peripheral nerves can be stimulated?

A
  • Ilioinguinal
  • Somatic peripheral
  • Occipital
  • Cranial Nerves
45
Q

What kind of stimulation type varies its waveforms and can cover a large range of pathology?

A

Burst stimulation

46
Q

What part of the spinal cord is the target for stimulators?

A

Dorsal root ganglion

47
Q

What does true CRPS look like?

A
  • Hyperalgesia
  • Swollen, smooth, glossy appearance
  • Injury precipitated it
  • Long-lasting
48
Q

What is the mild procedure?

A

Minimally invasive lumbar decompression procedure

49
Q

When are intrathecal pain meds given?

A

Last resort

50
Q

What are the common intrathecal meds?

A
  • Morphine
  • Baclofen
  • Hydromorphone
  • Fentanyl
  • Sufetanil
  • Clonidine
  • Bupivacaine
  • Prialt (sea snails)
  • Octreotide
51
Q

How do we begin opioid dosing?

A

IR dosing with 50-90 MME.

Morphine equivalents

Neuro (17 decks)

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