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Psychological Medicine Block (Unsorted) > Pain > Flashcards

Pain Flashcards

1
Q

Definition of pain

A

An unpleasant sensory/emotional experience associated with actual or potential tissue damage or described in terms of such damage

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2
Q

What is the duration of acute pain?

A

Less than 3 months

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3
Q

What is the duration of chronic pain?

A

More than/equal to 3 months

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4
Q

What are the 3 mechanisms of pain?

A

Nociceptive pain
Neuropathic pain
Nociplastic pain

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5
Q

What are the two causes of chronic pain?

A

Chronic Primary Pain

Chronic Secondary Pain

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6
Q

Describe the qualities of acute pain.

A

Pain of recent onset/probable limited duration
Useful life sustaining function
Facilitated healing through immobilization
Uncomplicated psychological processing/social appearance

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7
Q

Describe the qualities of chronic pain.

A

Pain persisting beyond healing of injury
Often no identifiable cause
Pain lasting for more than 3 months

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8
Q

What is nociceptive pain?

A

Arises from physical/potential damage to the body, reported from nociceptors to the brain by the nervous system.
Typically changes with movement, position and load

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9
Q

What are examples of nociceptive pain?

A

Bee stings, burns, tumors, inflammatory arthritis

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10
Q

Describe neuropathic pain.

A

Arises from damage to the nervous system (central or peripheral) either from disease, injury or pinching.

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11
Q

What are examples of neuropathic pain?

A 
Mechanical insults (hitting your funny bone) 
Multiple sclerosis, chemotherapy, alcoholism, phantom limb pain
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12
Q

What does neuropathic pain often feel like?

A

Stabbing, electrical, burning

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13
Q

What is nociplastic pain?

A

Arises from altered nociception
No clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors
No evidence for disease or lesion of the somatosensory nervous system causing the pain

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14
Q

What are examples of nociplastic pain?

A

Fibromyalgia (FMS), CRPS (complex regional pain syndrome)

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15
Q

Describe chronic primary pain.

A

Pain in more than/equal to one anatomical regions.
Associated with significant emotional distress/functional disability & that cannot be accounted for by another chronic pain condition.

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16
Q

List examples of chronic primary pain.

A 
Chronic widespread pain or fibromyalgia 
Complex regional pain syndrome (CRPS)
Migraines 
Temporomandibular disorders (TMD) 
Visceral (E.g. IBS) 
Musculoskeletal (non-specific LBP)
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17
Q

Describe chronic secondary pain.

A

Pain linked to other diseases as underlying cause

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18
Q

List examples of chronic secondary pain.

A

Cancer/cancer treatment
Persisting pain after normal healing time after surgery
Neuropathic pain (e.g. after stroke, diabetic neuropathy)
Orofacial/headache e.g. after injury/substances abuse
Musculoskeletal - disease process affecting bones, joints, muscles, related soft tissue (e.g. rheumatoid arthritis, osteoarthritis)

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19
Q

List the temporal patterns of chronic pain

A

Persistent
Intermittent
Persistent with overlaid attacks

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20
Q

Describe the difference between cancer and non-cancer pain.

A

Cancer pain is progressive, may be mixture of acute/chronic

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21
Q

What is nociception?

A

Neural process of encoding noxious stimuli

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22
Q

What is a noxious stimulus?

A

A stimulus that is damaging or threatens damage to normal tissues

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23
Q

What is a nociceptor?

A

High-threshold sensory receptor of the peripheral somatosensory nervous system that is capable of transducing and encoding noxious stimuli

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24
Q

Describe the organization of the sensory pathway.

A

Receptor (nociceptor): signal transduction
Primary afferent neuron: periphery to ipsilateral spinal cord
Second-order neuron:: to integrative centers in the thalamus
Third-order neuron: thalamus to higher centers

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25
Q

What is the function of the premotor/motor cortex?

A

Organize/prepare movements

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26
Q

What is the function of the cingulate cortex?

A

Concentrating/focusing

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27
Q

What is the function of the prefrontal cortex?

A

Problem solving/memory

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28
Q

What is the function of the amygdala?

A

Fear, fear conditioning, addiction

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29
Q

What is the function of the sensory cortex?

A

Sensory discrimination

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30
Q

Describe the function of the hypothalamus/thalamus.

A

Stress response, autonomic regulation, motivation

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31
Q

What is the function of the cerebellum?

A

Movement and cognition

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32
Q

List the function of the hippocampus.

A

Memory spatial cognition, fear conditioning

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33
Q

What is the function of the spinal cord?

A

Gating from the periphery

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34
Q

What does the sympathetic nervous system do?

A

Increases HR, mobilize energy, increase vigilance, sweat

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35
Q

What is the function of the motor system?

A

Run away, fight, protect the damaged area

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36
Q

What does the endocrine system do?

A

Mobilize energy stores, reduce gut and reproductive activity

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37
Q

List the functions of the pain production system.

A

Motivate to escape and seek help, attract attention

38
Q

What is the function of the immune system?

A

Fight invaders, sensitize neurons, produce fever, make sleepy to promote healing

39
Q

What does the parasympathetic nervous system do?

A

Nourish cells, heal tissue

40
Q

What is the mechanism of chronic pain?

A

Central sensitization

41
Q

List the characteristics of central sensitization.

A

Repeated noxious stimulation - enhanced perception of pain (hyperalgesia)
Ongoing noxious stimulation: neuroplastic changes = gene induction, synaptic strengthening

42
Q

List the psychosocial factors that correlate in the development and maintenance of pain.

A

Affective factors, behavioral factors, cognitive factors (e.g. attention, beliefs, expectations, attitudes), placebo effects, social influences, psychiatric and psychosomatic comorbidity

43
Q

Name the pyschological presentations associated with chronic pain.

A

Anxiety disorders, depression, sleep disorders, PTSD, abuse, unresolved or recent bereavement, problems with anger management, pain behaviours

44
Q

What does RAT stand for?

A

Recognize
Assess
Treatment

45
Q

What does recognizing pain involve?

A

Ask/observe if the patient has pain

Do other people know the patient has pain - health workers, patient’s family

46
Q

What does assessing pain incorporate?

A 
What provokes/relieves the pain? 
Quality - describe the pain 
Regions - where is the pain 
Severity - rest vs movement 
Timing - constant vs intermittent
47
Q

What are the questions to ask when assessing the pain? SOCRATES

A 
Site 
Onset 
Characteristics 
Radiates
Associated symptoms 
Timing 
Exacerbating/relieving factors 
Severity
48
Q

What are the different concepts needed in a diagnosis of pain?

A

Acute/chronic
Cancer/non-cancer
Nociceptive, nociplastic, neuropathic
Any other factors (physical, psychological, social)

49
Q

What are the different methods of measuring pain?

A

Body charts
Self report scales
Self report inventories

50
Q

List some important points to keep in mind when explaining chronic pain to patients.

A

Show compassion
Open mind about etiology
Open a dialogue about involvement of psychological factors
Asses for comorbid psychological problems
Realistic expectations
Don’t fall into a mind-body dichotomous thinking
Provide a conceptual model

51
Q

What treatment do you use for chronic non-cancer pain?

52
Q

What other types of drugs can you use for chronic pain?

53
Q

What does NSAIDs stand for?

A

Non-steroidal anti-inflammatory drugs

54
Q

What type of pain are opioids useful for?

A

Neuropathic pain

55
Q

What are the weak opioid agents?

A

Codeine, tramadol

56
Q

What are the strong opioid agents?

A

Morphine, oxycodone, fentanyl, methadone

57
Q

What problems are associated with opioids?

A

Side effects in 80% of patients - nausea, drowsiness, respiratory depression
Physical dependence, tolerance, addiction

58
Q

What are NSAIDs useful for?

A

Useful in short courses for pain “flare-ups”

Blocking enzyme COX (e.g. celecoxib)

59
Q

What is the mechanism for NSAIDs?

A 
Blocking enzyme COX (e.g. celecoxib) 
Decreases prostaglandins (inflammation, pain, fever)
60
Q

What are the side effects of NSAIDs?

A

GI, cardiovascular, renal

61
Q

What are antidepressants used for?

A

Neuropathic pain, headaches, fibromyalgia, LBP

62
Q

What types of antidepressants exist?

A 
Tricyclic antidepressants (e.g. amitriptyline) 
Serotonin-noradrenaline reuptake inhibitors SNRI (e.g. venlafaxine) --> less side effects
63
Q

What are anticonvulsants used for?

A

Neuropathic pain

64
Q

How do anticonvulsants work?

A

Reduce neurotransmission in abnormally active sensory neurons

65
Q

What are examples of anticonvulsants?

A

Gabapentin, pregabalin

66
Q

What are the side effects of gabapentin and pregabalin?

A

Sedation, dizziness

67
Q

What are antiarrhythmics used for?

A

Neuropathic pain

68
Q

What are examples of antiarrhythmics?

A

Lidocaine, mexiletine

69
Q

Describe what topical analgesics are used for.

A

Neuropathic pain with significant peripheral component (e.g. osteoarthritis)

70
Q

What are examples of novel and atypical agents?

A

Ketamine

Clonidine

71
Q

What are cannabinoids used for?

A

Cancer pain, neuropathic pain

72
Q

List the pharmalogical treatments of pain.

A 
Opioids 
NSAIDs 
Antidepressants
Anticonvulsants 
Antiarrhythmics 
Topical analgesics 
Novel and atypical agents 
Cannabinoids
73
Q

What are further medical treatments for pain?

A

Interventional therapies
Neuromodulation
Surgical techniques

74
Q

Describe what interventional therapies consist of.

A

Blocks off specific or several nerves

E.g. sympathetic nerve blocks for CRPS

75
Q

Describe what neuromodulation entails.

A

Transcutaneous electrical nerve stimulation (TENS)
Spinal cord stimulation
Deep brain stimulation, motor cortex stimulation

76
Q

What do surgical techniques fix?

A

Back pain

Correction of deformity/instability, relieves neural compressions, eradication of tumors/infections

77
Q

List the physical therapies available for treating pain.

A

Physiotherapy
Acupuncture
Osteopathy and chiropractic

78
Q

What does physiotherapy target?

A

Various types of chronic pain (especially musculoskeletal and neuropathic pain)
Deconditioning, loss of confidence in movement, fear avoidance

79
Q

What does physiotherapy consist of?

A

Manual therapy, electrophysical modalities, therapeutic exercise

80
Q

What pain does acupuncture target?

A

Musculoskeletal pain, back/neck pain, dental/facial pain headaches

81
Q

How does acupuncture work?

A

Stimulation of peripheral nervous system –> activating endogenous analgesic mechanisms

82
Q

What pain does osteopathy and chiropractic methods target?

A

Musculoskeletal pain, mechanical spinal and neck pain, headaches

83
Q

Describe how osteopathy and chiropractic methods work.

A

Manual techniques, high velocity thrust to a joint taking it beyond its restricted range of motion
Mobilization: soft tissue release methods

84
Q

List the psychological therapies for pain.

A

Cognitive behavioral techniques
Acceptance/mindfulness
Pain Management Programs

85
Q

What does CBT consist of?

A

Education
Assessing/modifying pain related beliefs
Stress management
Sleep strategies

86
Q

Describe what acceptance/mindfulness is.

A

Acknowledging that one has pain
Giving up unproductive attempts to control the pain
Commit effort toward living a satisfying life despite pain
Mindfulness-based strategies

87
Q

What are Pain Management Programs?

A

Education
Psychology input, graded exercise, communication/relationships, posture, managing everyday life, activities/work, realistic goals/pacing activities

88
Q

List the benefits of treating pain for the individual, family and society.

A

Patient - physical, psychological
Family - unable to function as part of family, loss of income
Society - health costs, unable to contribute to community

89
Q

Which ethnic group is less likely to report pain?

A

Asians and Pasifika

90
Q

Which ethnic groups experience the most chronic pain?

A

Europeans and Maori

Psychological Medicine Block (Unsorted) (15 decks)

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