Pain Flashcards
1
Q
Acute pain
A
- related to pathology/injury
- resolves w/ healing
- usually responds to tx
- prominent autonomic involvement
2
Q
Chronic pain
A
- last > 3 months
- may be unrelated to obvious pathology and healing
- tx often ineffective
- prominent psychiatric sx
3
Q
Pain epidemiology
A
- most common reason pt present to a provider
- leading cause of disability
- major contributor to health care cost
4
Q
Neruophysiology of pain
A
- tissue damage/ noxious stimuli
- peripheral changes
- neural pathways
- neuroregulators
- psychological effects and pain sensation
5
Q
peripheral changes in pain
A
- release of K, prostaglandins, and bradykinin
- mediator release from mast cells, platelets and blood vessles
6
Q
Neural pathways in pain
A
-transmission of nociceptive information from DRG to higher centers via anterolateral quadrant of spinal cord / spinothalamic tract
7
Q
Neuroregulators in pain
A
- excitatory: SP, ACh, Epi
- Inhibitory: NE, 5-HT, opioids, endogenous cannabinoids
8
Q
Placebo for pain
A
- pain is a dynamic sensation w/ multiple dimensions
- placebo effects are physiologic actions
- many active medications work via augmentation of these pathways
- Gabapentin works well
9
Q
Patient interview
A
- onset, location, radiation, aggravating/alleviating factors
- quality of pain:
- stabbing, squeezing, aching, boring, localized: nociceptive
- burning, stinging, shooting, radiation: neuropathic
- need to figure out how the pain is affecting their daily living and work life
10
Q
PMH
A
- comorbidities
- allergies
- previous tx
- labs/imaging — VERY IMPORTANT
11
Q
PE
A
- general exam
- pain-focused musculoskeletal exam: ROM, atrophy, deformity, joint instability, muscle spasm, tenderness
- pain-focused neurological exam: mental status, strength, sensory abnormalities (allodynia/hyperalgesia)
12
Q
Diagnositc tools
A
- MRI: preferred for visualization of the spine
- CT: if MRI contraindicated
- discogram: combination of imaging and injection
- X-ray
- US
- bone scan
- EMG/NCS: for suspected neuropathies
- Labs: tick-bone disease, inflammatory arthritis nutritional deficiences
13
Q
Modalities of pain tx
A
- alternative therapies
- interventions: injections, ablation, pain implants
- nonopioid medications
- opioids
14
Q
Non-opiod pain meds
A
- corticosteroids
- NSAIDs/tylenol
- antispasmodics
- anticonvulsants
- antidepressants
- topical agents
- supplements
15
Q
Antispasmodics
A
- Zanaflex, Flexeril, Robaxin, Baclofen
- Benzos (Valium, Xanax, Klonopin)
- better for acute tx than chronic tx
