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Orthopedics > Pain > Flashcards

Pain Flashcards

1
Q

What is nerve pain?

A 
Sharp
Lancinating
Bright
Burning
Shooting
Pins and Needles
Often following pathway of nerve

Ie: nerve root impingement, traction injury, carpal tunnel, sciatica

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2
Q

What is Bone Pain?

A 
Acute
Sharp
Severe
Intolerable
Ie: Fracture

Other:
Deep
Boring
Very localized

Ie: bone bruise, metastatic bone cancer

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3
Q

What is Joint Pain?

A

Acute:
Sharp
Localized

Ie: Grade 2 ACL tear/sprain, labral tear, meniscal tear

Subacute/Chronic:
Dull
Achy
Can be localized or not

Ie: Chronic Ligament tears

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4
Q

What is Muscular Pain?

A

Dull
Achy
Cramping
Often not localized

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5
Q

What is Vascular Pain?

A

Diffuse
Achy
Throbbing

Ie: coronary artery disease, vasculitis

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6
Q

What is Visceral Pain?

A

Diffuse
Achy
Poorly localized

Ie: appendicitis, IBS, food allergies

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7
Q

4 Types of Behaviour of Pain

A
  1. Constant
  2. Mechanical
  3. Episodic
  4. Irritability
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8
Q

What’s Constant Pain?

A

Unrelenting pain, even at night

Pain may fluctuate in severity but is always present

Typically chemical in nature, inflammation activates local nociceptors

RED FLAG FOR TUMOURS, VISCERAL LESIONS, CHEMICAL IRRITATION

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9
Q

What is Mechanical Pain?

A

Brought on by certain movements

Related to stress on a specific anatomical structure

MCL sprain, meniscal tear

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10
Q

What is Episodic Pain?

A

Related to specific activities, postures

Tends to come and go

Increasing frequency as time progresses

Often related to an ongoing disease process

Ie: DDD, facet joint syndrome, IBS

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11
Q

What is Irritability Pain?

A

Refers to the ease with which symptoms can be exacerbated

Indicator of stage of healing

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12
Q

Peripheralization vs. Centralization

A

P: Vs. C:

Pain travels further from source. Pain travels closer to source
Pain decreases in intensity. Pain increases with intensity
Occasionally pain will disappear at the source of irritation

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13
Q

When does Chronic Inflammation pain occur?

A

Typically presents as morning stiffness and pain with improves with activity

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14
Q

When does Joint or Soft Tissue Inflammation pain occur?

A

Typically presents later in the day as the patient as placed more stress on the tissues

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15
Q

When does Tumour pain occur?

A

Night pain, constant pain, often accompanied by fatigue and weight lose in later stages

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16
Q

Acute Stage

A

Inflammatory Stage

4-10 days (1-4 days)

Goal: Restore tissue homeostasis

Process:
1. Clotting ~ increased local blood vessel permeability causes a leakage of plasma proteins and the formation of an extravascular clot

  1. Chemical Mediators:
    Bradykinins - attracts neutrophils and macrophages
    Neutrophils - help clear bacterial and fungal pathogens
    Early inflammation stage
    Macrophages - same as neutrophils but also clear out dead cell
    Cells and debris, releases platelet growth factors
    To lay doesn’t foundation for the proliferation phase
    Later Inflammatory Stage
17
Q

Function of a clot?

A
  1. To hold would edges together
  2. To create a mechanical barrier to foreign material entering the wound
  3. To help prevent spread of infection
18
Q

What other structures also release Platelet Derived Growth Factors (PDGF)?

A

Platelets

Smooth muscle cells

Endothelial Cells

19
Q

Signs of Inflammation

A
  1. Heat/Redness
  2. Pain
  3. Swelling
20
Q

What is Inflammatory Exudate?

A

A fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation and is deposited in nearby tissues

Includes: Gamma Globulins
Leukocytes: Neutrophils, Macrophages, Lymphocytes,
Basophils

21
Q

Treatment goals for Acute Inflammatory Stage

A
  1. Decrease Bleeding: RICE for first 24/48 hours, NSAIDS
  2. Decrease pain: RICE first 24/48 hours
  3. Help remove excess inflammatory exudate a: METH
  4. Promote good scar tissue adhesion: gentle ROM within pain
    Tolerance, gently massage, pulsed ultrasound
22
Q

M.E.T.H meaning

A

Movement

Elevation

Traction

Heat

23
Q

Subacute Phase

A

Proliferation Phase

10 days - 7 weeks (4-6 days to 15 days)

Goal: Granulation and Scar Tissue Formation

Process:
1. Granulation tissue is new connective tissue with capillaries that form on the surfaces of a wound during the healing process.

  1. As each new capillary loop brings nutrients and oxygen to cells, fibroblasts are able to build more matrix and allows more macrophages and cells to migrate. Fibroblasts develop into myofibroblasts (wound contraction)
  2. Collagen Fibers (Formed by fibroblast) are formed and if left on their own form bundles that are not oriented in any particular direction. Coleen at this stage is weak and vulnerable to tearing
24
Q

What does Granulation Tissue consist of?

A

Macrophages

Fibroblasts

Endothelial Cells

25
Q

Treatment Goals for Subacute

A
  1. Fiber Orientation
    ~Mechanical Forces: AROM to orientate fibres along lines of
    Stress. Gentle Massage
    ~ Ultrasound: Increase collagen production and tensile strength
    Of the scar
  2. Protection: scar tissue is still quite vulnerable and needs to be
    Protected. Stress is kept to a minimum
26
Q

Chronic Stage

A

Remodelling/ Maturation Phase

Greater then 7 weeks (15 days -months up to several years)

Goal: Scar tissue remodelling

Process:
1. Basically Granulation tissue is being replaced by large bundles
Of collagen scar tissue

  1. Maturation (remodelling): main focus is to realign the collagen which began in the proliferation stage. Cells that are no longer needed are removed by programmed cell death “apoptosis”
    * Remodelling can last many years*
27
Q

Treatment Goals for Chronic Stage

A
  1. Optimum collagen Orientation: increasing vigorous and direction oriented exercise and deep transverse frictions if needed
  2. Return to regular activity
28
Q

Nature of Pain Types

A
  1. Nerve pain
  2. Bone Pain
  3. Joint Pain
  4. Muscular Pain
  5. Vascular Pain
  6. Visceral Pain

Orthopedics (22 decks)

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