Pain Flashcards
Acute pain
Sudden secondary to illness or injury, less than 3 months
Chronic or long term pain
Recurring pain greater than 3 months at least 1 month
Inflammatory lain
Worse in AM, seen in RA
Responds to NSAIDs, moving/stretching, and heat
Neuropathic pain
Shingles, diabetic neuropathy
Burning, shooting, changes with hot/cold
Lesions in central/peripheral nervous system
Pain
Unpleasant sensory and emotional experience related to/resembling actual or potential tissue damage
Nociceptors
Sensory receptors in peripheral somatosensory nervous system, transduces and encodes noxious stimuli
Nocioplastic pain
Result if altered nociception without evidence of threat/actual tissue damage or disruption to somatosensory nervous system
Pain Assessment
Pain level at rest and with activity, use pain scales pt’s will understand,
Impact on function/functional limitations
Understanding pain mgmt strategies
Psycho social needs
Allodynia
Pain due to stimuli that does not normally provoke pain, unexpected
Analgesia
Absence if pain stimuli which would normally be painful
Anesthesia dolorosa
Pain in region which is an esthetic, trigeminal nerve
Causalgia
Syndrome of sustained burning oain, allodynia and hyperapathia after a traumatic nerve lesion
Combined with vasomotor abdominal sudomotor dysfunction and later trophic changes
Dysesthesia
Unpleasant abnormal sensation whether spontaneous or evoked
Differs from paresthesia as paresthesia may not be unpleasant, dysesthesia is unpleasant
Hyperalgesia
Increased pain from stimuli that normally provokes lain, increased lain on suprathreshold
Hyperesthesia
Increaser sensitivity to stimuli excluding special senses, locus/stun specified, cutaneous sensibility ie touch/thermal may be with or without pain
Hyperapathia
Painful syndrome with abnormally painful reaction to stimulus especially repetitive stimuli as well as increased thresholds
Hypoalgesia
Decreased pain response to normally painful stimulus
Hypoesthesia
Decreased sensitivity to stimulation, excludes special senses
Neuralgia
Pain in distribution of nerve
Neuritis
Inflammation of nerves
Neuropathic pain
Pain by lesion or disease of somatosensory nervous system
Central neuropathic pain
Caused by lesion or disease if central nervous somatosensory system
Peripheral neuropathic pain
Pain due to lesions/disease of peripheral somatosensory system
Neuropathy
Disturbance of function or pathological change in a nerve, if diffused b/l =polyneuropathy
Nociceptive pain
Pain from actual/threatened damage to non neural tissue secondary to activation of nociceptors
Pain threshold
Min intensity of stimulis that is perceived as painful
Pain tolerance
Max intensity of pain producing stimuli subject is willing to accept
Paresthesia
Abnormal sensation
Sensitization
Increased responsiveness of neurons to normal input, response to normally subthreshold inputs
Central sensitization
Central nervous somatosensory
Arthritis types
RA
Lupus
Fibromyalgia
OA most common
Gout
Psoriatic arthritis
OA
Hands, hips, knees, cartilage within joint breaks down and underlying bone changes
Develops slowly worsens overtime
Sx: pain/aching, stiffness, decreased ROM, swelling
RA
Autoimmune/inflammatory disease with increased inflammation
Many joints at once, joint lining becomes inflamed, long-lasting pain, unsteadiness, and deformity
Effects lungs, heart, and eyes as well
Sx: pain/aching in more than 1 joint, stiffness, swelling, tenderness, same symptoms bilaterally, weight loss, fever, fatigue, weakness
RA risk factors
Age, sex (2-3x more in women), smoking, live births, early life exposures, genetic, obesity
Breast feeding reduces risks
Medical tx=medication/self mgmt strategies
Complications include premature heart disease, obesity, decreased employment and work loss
Gout
Inflammatory arthritis affecting 1 joint at a time
Characterized by flares with worsening symptoms multiple times
Caused by hyperuricemia, increased uric acid
Tx: manage pain w. NSAID/diet prevent flares by limiting alcohol and med mgmt
Fibromyalgia
Caused by pain all over the body
Sx: sleep problems, fatigue, emotional/mental distress, increased sensitivity of pain, pain/stiffness all over body, depression/anxiety, problems with concentration, memory, thinking, headaches, tingling/numbness in hand and feet, digestive problems, pain in face/jaw
Fibromyalgia risk factors
Age
H/o lupus/R
Sex (2x more in women)
Stressful/traumatic events
Repetitive injuries
Family history
Obesity
Illness
Fibromyalgia complications
Increased rheumatic conditions, increased suicide/injury rates, increased depression, decreased QOL, increased hospitalizations
Fibromyalgia treatment
Medication, aerobic exercise, pt education, stress mgmt, good sleep habits, CBT
Psoriatic arthritis
Chronic inflammation of skin, joints with pain, stiffness, swelling, alongside psoriasis, chronic autoimmune skin disease increased growth cycle of skin cells
Lupus
Chronic autoimmune disease, attacks itself
Arthritis Assessment tools
COPM assesses pain, ROM, functional limitations, psychosocial needs, support/access to equipment
RA interventions
Physical activity: aerobic, resistive, aquatic exercise, tai chi, yoga, dynamic exercise
Psychoeducational: evidence supports gen. Ed on RA, CBT, self-mgmt, joint protection, symptom mgmt and self
Arthritis self mgmt program
Improved tenderness/swelling x 4 sessions
Includes mindfulness techniques, self-efficacy to increase psychosocial and physical function
OA intervention
Psychoeducational: increases feelings of fulfillment, guided imagery, progressive muscle relaxation =effective pain mgmt, moderate evidence for CBT for sleep/pain mgmt
Physical activity: strong evidence, increased physical activity decreases pain and increases fulfillment
Diaries, education, groups, tailored activity programs
Moderate evidence for tai chi, aquatic, aerobic, resistive
Fibromyalgia intervention
Multidisciplinary/multi-component interventions
Strong evidence for aquatic tx to increaser function and reduce pain/stiffness
mindfulness based tx, mod support of CBT, strengthening, aerobic
8-12 week, yoga, pilates, tai chi
Lupus intervention
Strong evidence if 10 week CBT with emphasis on a decreased stress, depression, anxiety and increase ability to function socially
Mod evidence for psychoeducational intervention, group vs couple therapy
