MOD 2 Mechanism-Based Pain Classifications Flashcards
What is a mechanism-based pain classification?
general groupings of neurobiological processes involved in and dominating the pain experience
What are the 5 major pain mechanism categories?
- nociceptive
- neuropathic
- nociplastic
- disputed
- mixed
What subgroups of pain are included in nociceptive pain?
- general
- mechanical
- ischemic
- inflammatory
What subgroups of pain are included in neuropathic pain?
- general
- peripheral
- central
What subgroups of pain are included in nociplastic pain?
central
- sensitization
What subgroups of pain are included in disputed pain?
- sympathetic
- psychogenic
What subgroups of pain are included in mixed pain?
combo of nociceptive, neuroplastic, and nociplastic with multiple mechanisms
What is nociceptive pain?
pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors
What is neuropathic pain?
pain caused by a lesion or disease of the somatosensory nervous system
What is nociplastic pain?
pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain
What are the methods for discriminating pain mechanism categories?
- imaging
- diagnostic and lab testing
- pain type questionnaires
- clinical examination
What are symptom descriptions of nociceptive pain?
- deep, dull ache, sharp, local and clear
- aggravating and easing factors
- no electric, no shooting, no numbness, tingling, night pain
What are some symptoms of neuropathic pain?
- burning, electric shock
- paresthesia, numbness
- could be dermatomal or cutaneous pattern
- aggravated by load or compression on neural tissue
What are symptoms of nociplastic pain?
- constant, even at rest
- diffuse, widespread, generalized, poorly localized, non anatomic distribution
- temporal summation, hyperalgesia
- disproportionate to the nature of pathologic changes or injury, persists past healing
What might you find during a physical exam of nociceptive pain?
- reproducible on mechanical testing, clear, consistent
- no remote tenderness or pain
- no abnormal neuro findings
- normal pain and detection thresholds
- normal conditioned pain modulation and temporal summation
What are physical exam techniques to be used for nociceptive pain?
- orthopedic tests and measures
- near tests and measures
- function
- pain level
What might you find in a physical exam for neuropathic pain?
- neuroanatomical pain distribution
- sensory abnormalities in dermatomal pattern
- motor findings in myotomal or peripheral nerve root distribution
- abnormal pain thresholds
- abnormal local detection thresholds
What does a physical exam for neuropathic pain look like?
sensory t/m: dermatome/cutaneous
motor
- recruitment
- control
- endurance
- myotomes
reflexes
neurodynamic and nerve provocation testing
What might you find during a physical exam for nociplastic pain?
- inconsisitent, confusing, ambiguous response, findings
- disproportionate, inconsistent nontechnical or non anatomical pain provocation
- altered body perception
- left right discrimination
- diminished tactile acuity
What does a physical exam look like for nociplastic pain?
- graphesthesia (draw on area of pain)
- left right discrimination testing
- tactile acuity (2 point discrimination, stimulus localization)
- mechanical detection thresholds testing
- temperature pain thresholds testing
- pain modulation testing
What are the chances that someone has a psychological impact on their pain for nociceptive, neuropathic, or nociplastic pain?
nociceptive: minimal or absent
neuropathic: minimal
nociplastic: significant
What are the goals of nociceptive pain treatment?
- decrease perception of pain
- improve function (ROM, control, strength)
What are the goals of neuropathic pain treatment?
- improve nerve health
- improve neural transmission
- creating healing environment: space, movement, blood flow
What are the goals or nociplastic pain treatment?
- cortical re-mapping
- create a healing environment
