MSK Pain assessment Flashcards
What is the definition of Pain
unpleasant/sensory experience that is associated with actual or potential tissue damage
may also be associated with perceived tissue damage or psychological pathologies
What is acute pain
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
What is Chronic pain
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
what are the 2 types of chronic pain
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
What is nociceptive pain
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
What are the 3 main causes of nociceptive pain
mechanical (stubbing toe, straining muscle)
Thermal (touching hot or cold surface)
Chemical (bleach or other chemical damage)
How does nociceptive pain occur if nociceptors traditionally have a high AP threshold?
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
What is neuropathic pain
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
What is nociplastic pain
pain that is a result of altered nociception w unclear evidence of tissue damage
theorized to be associated with chronic pain
is revertable
What is idiopathic pain
pain of unknown origin, no obvious pathology
what is referred pain
pain felt @ a different location than the site of origin, often due to the neuronal referral pathways
What is subjective pain assessment
self-report of pain from the individual who is experiencing it
What is physiological pain assessment
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
What is behavioural pain assessment
facial expressions and altered sleep cycles
consider gender and culture, as this can lead to inhibited pain expression
What is cognitive pain assessment
affected cognitive abilites due to pain
will vary based on individuals developmental age
What is psychological and social pain assessment
pt may become anxious, irritable, or upset
social withdrawl and depression
What is reactive pain assessment
refers to the way pain interferes with daily function (walking, sleep, relationships, etc)
how does gender bias affect pain assessment
pain exhibited by men often taken more serious, which may influence treatment options available to other genders
What is the Numeric rating scale
0-10 pain scale
easy to use and quick
not suitable for kids under the age of 8 or those with cognitive impairment
what is the visual analogue scale
horizontal line with 2 anchors, pt points to where between the points they are at
best used for adults, similar to NRS
What is the verbal descriptor tool
describe pain intenstiy with words (very mild, mild, severe)
useful when pt prefers descriptors
What is the faces pain scale
faces indicate pain, good for young kids and those with poor linguistic ability
What is the Sun-cloud pain scale
0-5 scale, increase in pain as you get stormier
good for other cultures
what is esthesia
feeling
what is algesia
pain
what is the substantia gelatinosa
space between first and second-order neurons
What is transduction
conversion of stim from one form to another
what is allodynia
pain due to stim that usually doesnt cause pain, usually associated with central centralization/peripheral neuropathic pain
What is the gate control theory
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
how do nerves fire
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
What are the 2 types of nociceptors
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
What are some signs and symptoms of nociceptive pain
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
What are some signs and symptoms of peripheral neuropathic pain
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)
What are some signs and symptoms of nociplastic pain
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
