mahoney 1

Question 1

what percentage of patients in primary care have clinical depression

Answer 1

13 to 25% have clinical depression

Question 2

most common drug choice for treating both pain and depression in the same patients

Answer 2

Tricyclic antidepressants

Amitriptyline, nortriptyline, doxepin

Question 3

fibromyalgia definition

Answer 3

• pain disorder related to chronic fatigue syndrome in which patients have physiological malfunction in the interpretation of pain
  
  • many health professionals DO NOT recognize it as a disease
• sensations become unpleasant at STIMULUS INTENSITIES that are SIGNFICANTLY LOWER than those observed in healthy controls
• most common “systemic” illness assocaited with HEEL PAIN
• A non-inflammatory disease of soft tissue so there is NO JOINT SWELLING DETECTED

Question 4

what are the cahracteristics of fibromyalgia

Answer 4

• can’t fall asleep or more common have fitful, continuously INTERRUPTED SLEEP
• Migraine headaches common
• DEPRESSION
• burning pain, swelling in extremtiies
• IRRITABLE BOWEL SYNDROME

Question 5

Complex regional pain syndrome

Answer 5

• variety of painful conditions following injury which appears regionally ahve a distal predominance of abnormal findings
• exceeds in both magnitude and duration
• may result in significant IMPAIRMENT OF MOTOR FUNCTION
• shows variable progression over time

Question 6

CRPS 1

Answer 6

• develops after initiating noxious event (usually, a motor injury like sprain or stress fracture)
• SPONTANEOUS PAIN or allodynia/hyperalgesia occurs that extends FAR BEYOND THE AREA OF INJURY, and pain OUT OF PROPORTION
• Sympathetic nerve dysfunction leading to edema, erythema, warmth or coldness to touch

Question 7

CRPS II (casalgia)

Answer 7

• all signs of symptoms from CRPS
• DEVELOPS AFTER DIRECT NERVE INJURY
• has sympathetic enrve dysfunction

Question 8

SMP (sympahtetically maintained pain)

Answer 8

• pain maintained by sympathetic efferent innervation or by circulating catecholamines that is also out of proportion and not associated with any specific nerve
• CLASSIC SYMPATHETIC CHANGES TO SKIN NOT SEEN

Question 9

DIAGNOSIS/TX of CRPS I

Answer 9

• EARLY DIAGNOSIS Based on heightened degree of vigilance offers best change for recovery which among other things will involve AGGRESSIVE PHYSICAL THERAPY
• Immobility will only aid in advancing the disease
  
  • depressed or anxious people are MORE PRONE to developing CRPS

Question 10

Diabetes mellitus and depression

Answer 10

• Depression leads to poorer physical and mental function, so person is less likely to follow a required diet/medication plan
  
  • more likely to develop diabetic complications
• Depressive symtpoms can increase risk of diabetese and are related to HIGHER LEVELS OF INSULIN RESISTANCE
• Type 2 diabetics have a 24% increased risk of depression
• DEPRESSION is a risk marker for DELAYED HEALING AND RECURRENCE of foot ulcers!!!