Musculoskeletal pain Part 1

Question 1

Definition of pain

Answer 1

“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”

Question 2

What is the modern theory of pain?

Answer 2

Gate control theory of pain

Question 3

What is the gate control theory of pain

Answer 3

Move from traditional medical model to biopsychosocial model

Pain input to brain is controlled via a ‘gate’ in the spinal cord

Gate controlled by:

 pain fibres at site of injury

• pain fibres elsewheredescending messages from brain

Question 4

What does the gate control theory of pain explain that other models have not?

Answer 4

Variable relationship between pain and injury- pain can be produced by non painful stimuli
Pain produced by innocuous stimuli
Referred pain - when pain is felt in different parts of the body to the tissue damage

Pain in the absence of injury
Persistence of pain after healing
Painless injury
Placebo effect

Question 5

What are the differences in acute and chronic pain?

Aetiology( cause)

Answer 5

Acute-Result of injury or disease - normal physiological response

Chronic- Can be related or unrelated to tissue damage, can persist beyond normal healing

Question 6

What are the differences in acute and chronic pain?

Purpose

Answer 6

Acute- Important protective role and be aware of environment

Chronic- No useful biological function

Question 7

What are the differences in acute and chronic pain?

Duration

Answer 7

Acute- Short

Chronic- Long (>3-6 months)

Question 8

What are the differences in acute and chronic pain? MSK examples

Answer 8

Acute- Fracture, muscle sprain, acute post-operative pain

Chronic- Chronic back pain, osteoarthritis, chronic post-surgical pain

Question 9

What is congenital analgesia

Answer 9

Lose the ability to feel pain

Question 10

What is key about pain assessment?

Answer 10

Multidimensional

Question 11

What does the pain assessment cover?

Answer 11

Sensory aspects of pain
e.g. intensity, location, frequency, quality

Physical function
e.g activity levels, exercise, daily life

Emotional well-being/psychological impact
e.g. pain-related distress, depression, coping

Role and interpersonal functioning
e.g. work, relationships, social activities

Question 12

What is important to remember when assessing pain?

Answer 12

Pain is subjective
We can never know someone else’s pain, we can only know our own pain
To assess someone else’s pain, we have to rely on their reports of pain

Question 13

How do we assess pain?

Answer 13

Doctors need to listen to their patients and try to understand the pain experience

In some situations, you need to collect standardised information about pain e.g. research

Question 14

How is information about pain collected?

Answer 14

Using patient-reported outcome measures

Question 15

When is pain assessment quick and efficient

Answer 15

Trauma

Acute post-operative pain

Question 16

What types of pain assessment is used that are quick and efficient

Answer 16

Verbal Descriptor Scale
Numeric Rating Scale
Visual Analogue Scale

Question 17

In pain assessment what options are the Verbal Descriptor Scale

Answer 17

No pain
Mild pain
Moderate pain
Severe pain

Question 18

In pain assessment what options are the Numeric Rating Scale

Answer 18

0- No pain
1
2
3
4
5
6
7
8
9
10- Worst possible pain

Question 19

In pain assessment what options are the Visual Analogue Scale

Answer 19

Put a marker on a scale between no pain and pain as bad as it could

Question 20

What is important about assessing acute pain

Answer 20

Repeat assessment of pain important to ensure optimal pain management over time

Question 21

What is different about assessing chronic than acute pain

Answer 21

have time to conduct a full assessment

patients who have lived with his pain for a long time important to really understand their pain experience

Question 22

Examples of chronic pain assessment

Answer 22

Disease-specific e.g ICOAP

Generic: Brief Pain Inventory

Question 23

What does Generic: Brief Pain Inventory assess

Answer 23

used to assess pain in any condition
assesses pain severity and pain interference
such as how much pain interferes with sleep, mood and relationships

Question 24

What does Disease Specific pain assess?

Answer 24

assessed aspects of pain that a characteristic of a specific condition

Question 25

What does the Disease-specific: ICOAP assess? What does it stand for?

Answer 25

osteoarthritis

intermittent and constant osteoarthritis pain score

Question 26

What pain do patients with osteoarthritis experience?

Answer 26

constant dull aching and the shot and unpredictable intermittent pain

Question 27

Some challenges of using questionnaires to assess pain 4

Answer 27

Pain fluctuates over time because of many factors such activity levels and mood- some questionnaires ask for average pain per month which assumes that pain is static

When asking patients about pain severity over a long period of time like a month = recall bias (more likely to remember severe pain than mild pain)

Impact of co-morbidities and pain elsewhere- people with musculoskeletal pain have this - questionaires ask about particular area, really difficult to differentiate and separate out the different pains that they experience

Adaption and avoidance strategies- people with chronic pain develop this - may underreport amount of pain experienced

Question 28

When is a non-verbal assesment needed?

Answer 28

Some patients may be unable to self-report their pain: advanced dementia, infants and preverbal toddlers, unconscious, intellectual disabilities, end of life.

Question 29

What are the hierarchy of pain assessment techniques

Answer 29

Self-report
Identify potential causes of pain
Observe patient behaviours e_g. behavioural pain assessment tools
Surrogate reporting of pain with carer
Attempt an analgesic trial

Question 30

Why are pain assessments important? 4

Answer 30

To understand the pain intensity, qualities and impact
To aid in diagnosis
To help decide on the choice of treatment
To evaluate relative effectiveness of different treatments