MSK Pain assessment

Question 1

What is the definition of Pain

Answer 1

unpleasant/sensory experience that is associated with actual or potential tissue damage

may also be associated with perceived tissue damage or psychological pathologies

Question 2

What is acute pain

Answer 2

Short/limited in duration, and usually very specific

subsides when cause of pain is fixed

usually involves:

Changes in vitals (HR, BP, Temp, etc)
Excessive sweating due to higher body temp
Upset GI tract
increased blood glucose/pupil dilation

Question 3

What is Chronic pain

Answer 3

pain that lasts 3+months, persisting beyond typical healing time (ie backpain, migranes, arthritis, post surgical/traumatic pain)

symptoms involve:
sleep dysruptions
mood swings
interference w daily activities
cognitive impairment
social/relational effects

Question 4

what are the 2 types of chronic pain

Answer 4

primary - condition not understood and unaccounted for by another cause

secondary - results from a known disease or pathology (cancer, infection, etc), with the pain being a secondary symptom to that condition

Question 5

What is nociceptive pain

Answer 5

noxious stim that activates nociceptors with the potential to cause non-neural injury

activates somatosensory peripherals, causing it to be specific in location

can be somatic (originating in peripheral tissue) or visceral (originating in internal organs)

responds to NSAIDS, Opioids, etc, and is usually resolved with healed tissue

Question 6

What are the 3 main causes of nociceptive pain

Answer 6

mechanical (stubbing toe, straining muscle)

Thermal (touching hot or cold surface)

Chemical (bleach or other chemical damage)

Question 7

How does nociceptive pain occur if nociceptors traditionally have a high AP threshold?

Answer 7

tissue damage causes an increase in the presence of sensitizing agents (like H+), and these increase the sensitivity and decrease the AP threshold

increased firing means there is more pain stimuli sent to the brain, and this increased sensitivity results in inhibition of repolarization, so there is constant pain stimuli and input

However nociceptors have a small diameter which means they have slow conduction of the signals

Question 8

What is neuropathic pain

Answer 8

originates from damage to somatosensory nervous system

causes increase in sensitivity to touch/temp

leads to pain that is tingling, shooting, burning, stabbing, and numbing

related to nerve trauma and can be peripheral and central

Question 9

What is nociplastic pain

Answer 9

pain that is a result of altered nociception w unclear evidence of tissue damage

theorized to be associated with chronic pain

is revertable

Question 10

What is idiopathic pain

Answer 10

pain of unknown origin, no obvious pathology

Question 11

what is referred pain

Answer 11

pain felt @ a different location than the site of origin, often due to the neuronal referral pathways

Question 12

What is subjective pain assessment

Answer 12

self-report of pain from the individual who is experiencing it

Question 13

What is physiological pain assessment

Answer 13

monitoring physiological responses to pain (tense muscles, pupil dilation, dry mouth, change in vitals)

important to consider with acute pain and nonverbal individuals

vitals shouldnt be used alone tho, as it can be caused by a variety of factors

Question 14

What is behavioural pain assessment

Answer 14

facial expressions and altered sleep cycles

consider gender and culture, as this can lead to inhibited pain expression

Question 15

What is cognitive pain assessment

Answer 15

affected cognitive abilites due to pain

will vary based on individuals developmental age

Question 16

What is psychological and social pain assessment

Answer 16

pt may become anxious, irritable, or upset

social withdrawl and depression

Question 17

What is reactive pain assessment

Answer 17

refers to the way pain interferes with daily function (walking, sleep, relationships, etc)

Question 18

how does gender bias affect pain assessment

Answer 18

pain exhibited by men often taken more serious, which may influence treatment options available to other genders

Question 19

What is the Numeric rating scale

Answer 19

0-10 pain scale

easy to use and quick

not suitable for kids under the age of 8 or those with cognitive impairment

Question 20

what is the visual analogue scale

Answer 20

horizontal line with 2 anchors, pt points to where between the points they are at

best used for adults, similar to NRS

Question 21

What is the verbal descriptor tool

Answer 21

describe pain intenstiy with words (very mild, mild, severe)

useful when pt prefers descriptors

Question 22

What is the faces pain scale

Answer 22

faces indicate pain, good for young kids and those with poor linguistic ability

Question 23

What is the Sun-cloud pain scale

Answer 23

0-5 scale, increase in pain as you get stormier

good for other cultures

Question 24

what is esthesia

Answer 24

feeling

Question 25

what is algesia

Answer 25

pain

Question 26

what is the substantia gelatinosa

Answer 26

space between first and second-order neurons

Question 27

What is transduction

Answer 27

conversion of stim from one form to another

Question 28

what is allodynia

Answer 28

pain due to stim that usually doesnt cause pain, usually associated with central centralization/peripheral neuropathic pain

Question 29

What is the gate control theory

Answer 29

Inhibition of nociceptive pain by utilizing A-beta fibres (non nociceptive info) to activate inhibitory interneuron to close the gate @projection cells, inhibiting pain signals

A - beta fibers have a lower threshold and are faster, therefore they can beat out nociceptive pain signals

however a high enough pain stimulus can override the inhibition and can open the gate

this means things like massage, stretching, mobilization can all reduce pain as they would stimulate A-beta fibres, and this would inhibit the pain

opiods block substantia gelatinosa from sending info up the spinal tract

Question 30

how do nerves fire

Answer 30

depolarization as Na2+ ions rush into the cell, enough need to go in to become an AP, then K+ goes out the cell, and then Na2+ leaves through the Na/K pump to go back to resting

Question 31

What are the 2 types of nociceptors

Answer 31

c-fibres (chemical/thermal) (1m/s due to unmylenated) - cause a slow, deep throbbing vague pain

a-delta fibres (mechanical) (15 m/s) - sharp, localized, fast pain

Question 32

What are some signs and symptoms of nociceptive pain

Answer 32

localized pain to area of injury

clear proportionate mechanical/anatomical nature to aggrivating/easing factors

sharp pain with movement/mechanical provocation

pain in association with other dysethesias

absense of night pain and antalgic postures

burning, shooting, sharp, or electrical shock-like pain

Question 33

What are some signs and symptoms of peripheral neuropathic pain

Answer 33

pain referred in a dermatomal or cutaneous distribution

pain/symptom provocation w mechanical/movement tests (active/passive, neurodynamic) that move or load or compress neural tissue

SLR test supported as an indicator for radicular LBP (disk herniation/radiculopathy)

Question 34

What are some signs and symptoms of nociplastic pain

Answer 34

disproportionate, nonmechanical, unpredictable pattern of pain provocation in response to multiple non specific aggravating/easing factors

presence of diffuse areas of tenderness on palpation

disproportionate aggravating/easing factors