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Morgan E&M > Pain Lecture > Flashcards

Pain Lecture Flashcards

1
Q

Nociception

A

Stimulation of peripheral pain nerve endings, transmit signal to CNS

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2
Q

Pain

A

Unpleasant sensory/emotional experience associated w actual/potential tissue damage

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3
Q

Suffering

A

Subjective evaluation on pain experience

Feeling associated w/anticipation of/actual threat to wellbeing

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4
Q

Pain behavior

A

Observable actions in response to pain/suffering

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5
Q

Acute Pain

A
  • signal for real/impending tissue damage
  • biological dysfunction
  • concurrent w/ tissue damage or stress
  • disappears w/healing
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6
Q

Chronic/Persistent pain

A
  • pain persisting after healing is complete
  • 3 months (arbitrary)
  • process, not an entity (they need to accept and live w pain)
  • emotional pain, physiological factors, behavioral factors
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7
Q

Chronic pain consists of

A

Autonomic dysfunction, CNS dysfunction, metabolic changes in painful tissue, motor control dysfunction, self, psychosocial

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8
Q

OLDCARTS

A 
Onset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Temporal
Severity
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9
Q

Onset of pain

A
  • sudden or gradual/insidious
  • mechanics of injury if trauma
  • first time? Reoccurrence?
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10
Q

Location

A
  • where
  • has it spread or focused?
  • does it change with activity?
  • does it change w body positions?
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11
Q

Duration

A

How long does it last?

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12
Q

Characteristics

A

How severe is it? Is it sharp/dull/throbbing?

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13
Q

Behavior (A/R)

A

Aggravating: what increasing pain– red flag if doesn’t change
Relieving- what makes it better

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14
Q

Temporal

A

When does the pain occur?

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15
Q

Severity rating

A

Number ranking, adjectives

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16
Q

Interview questions for pain

A
  • past treatments, meds, HCP
  • describe original pain/onset mechanisms
  • stress factors
  • perception of cause of continued pain
  • how will you know when you’re better?

Goals should be functionally oriented, not dependent on pain cessation!

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17
Q

Body diagrams for pain

A
  • specific anatomical location
  • referred pain
  • trigger points
  • myofascial pain
18
Q

Physical exam for pain

A 
Movement patterns
Neuro exam
AROM
Muscle strength
Posture
19
Q

Cyriax concept– active movement

A
  • specific soft tissue can’t be incriminated

- provides info on mvmnt ability, painful range, possible originating pain location

20
Q

Cyriax concept– passive movement

A
  • inert structures like capsule, ligaments, bursa, fascia

- gross assessment on length of soft tissue

21
Q

If both passive and active movement restricted in same direction

A

Indicative of capsular/arthrogenic lesion

22
Q

If active an passive actions are restricted/painful in opposite directions

A

Contractile lesion

23
Q

Resisted isometric testing– do where and what is contraindication?

A
  • isolate contractile tissue in midrange

- ci = fracture close to muscle insertion or inflamed muscle

24
Q

Isometric testing– strong and painless

A

WNL/referred pain

25
Q

Strong and painful

A

Minor lesion of muscle/tendon

26
Q

Weak and painless

A
  • disorder of nervous system
  • total rupture of myotendinous unit
  • disuse atrophy
27
Q

Weak and painful

A
  • major lesion– fx, neoplasm
  • acute inflammation
  • partial rupture of myotendinous unit
28
Q

Pain pattern- painful arc

A
  • tender structure between two bony surfaces

- Subacromial bursa: 60 to 120 degrees shoulder abduction

29
Q

Pain pattern- pain w/ repetition of movements

A

Intermittent claudication

30
Q

Where is capsule laxest for..

Hip? Knee? Ankle?

A 
Hip = 30 degrees of flexion
Knee = 30-45 degrees of flexion
Ankle = 15 degrees of plantarflexion
31
Q

Central pain– thalmic pain

A

Continuous aching/burning

Lesion in thalamus, maybe post-stroke

32
Q

Complex regional pain syndromes

A

Reflex sympathetic dystrophy

Causalgia

33
Q

RSD

A

Reflex Sympathetic Dystrophy:

  • early stage: pain w slight increase in skin temp, localized edema, muscle spasm
  • dystrophic stage: pain w lowered skin temp, hyperhidrosis, muscle atrophy

-so it goes from increased temp and swelling and spasm to cold skin excessive sweating and muscle atrophy

34
Q

Causalgia

A

Burning sensation after partial peripheral nerve injury, trophies changes such as loss of sweat glands/hair, thinning skin

35
Q

Wadell’s test

A

Tenderness, simulation, distraction, regional disturbances, overreaction

36
Q

What does Waddell test test for

A

-screening for nonorganic, psychological and social elements to pain syndrome– apparently doesn’t signify malingering but that’s kinda bullshit

37
Q

What score do you look for to determine symptom magnification/possible illness behavior?

A

Greater than 3

38
Q

What is type II of Waddell test

A

SIMULATION:

Axial loading/rotation

39
Q

What is type IV of Waddell test?

A

REGIONAL DISTURBANCES

Weakness, sensory

40
Q

What is type V for Waddell

A

Overreaction

41
Q

What is type I of Waddell

A

TENDERNESS

-superficial, non-an atomic

42
Q

What is type III of Waddel’s test?

A

DISTRACTION

SLR

Morgan E&M (8 decks)

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