Pain

Question 1

Chronic pain

Answer 1

Pain not associated w/ cancer or other medical conditions that persists for more than 3-6 months; pain lasting > 1 month beyond course of an acute illness or injury; or pain recurring at intervals of months or years.

Question 2

Nociceptive (somatic) pain

Answer 2

Linked to tissue damage to skin, musculoskeletal system, or viscera (visceral pain) but sensory nervous system is intact, as in arthritis or spinal stenosis. Acute or chronic. Mediated by afferent A-delta & C-fibers of sensory system. Involved afferent nociceptors can be sensitized by inflammatory mediators & modulated by both psychological processes & neurotransmitters like endorphins, histamines, acetylcholine, serotonin, norepinephrine, & dopamine.

Question 3

Neuropathic pain

Answer 3

Direct consequence of a lesion or dz affecting somatosensory system. Over time, may become independent of inciting injury, becoming burning, lancinating (stabbing/ piercing), or shock-like in quality. May persist even after healing from initial injury has occurred. Mechanisms postulated to evoke neuropathic pain include CNS brain/ spinal cord injury from CVA/ trauma; peripheral nervous system d/o causing entrapment/ pressure on spinal nerves, plexuses, or peripheral nerves; & referred pain syndromes w/ increased/ prolonged pain responses to inciting stimuli. These triggers appear to induce changes in pain signal processing thru “neuronal plasticity” leading to pain that persists beyond healing from initial injury.

Question 4

Central sensitization pain

Answer 4

An alteration of CNS processing of sensation exists, leading to amplification of pain signals. There’s a lower pain threshold to no painful stimuli, & the response to pain may be more severe than expected. I.e. FIBROMYALGIA, which has as strong overlap w/ depression, anxiety, & somatization d/o & responds best to meds that modify neurotransmitters like serotonin & dopamine.

Question 5

Psychogenic pain

Answer 5

Involves many factors that influence pt’s report of pain— psychiatric conditions like anxiety or depression, personality & coping style, cultural norms, & social support systems.

Question 6

Idiopathic pain

Answer 6

Pain w/o an identifiable etiology