Pain Mechanisms in Practice Flashcards
1
Q
Signs + Symptoms of Nociceptive Pain
A
- intermittent
- sharp with movement/mechanical
- dull ache/throb @ rest
- localised to area of injury + w/ or w/o somatic referral
- clear, proportionate mechanical/anatomical nature to aggravating and easing factors
2
Q
What signs and symptoms would be absent in nociceptive pain?
A
- pain is not burning, shooting, sharp or electric (dysesthesia)
- lack of night pain/disturbed sleep
- lack of antalgic (pain relieving) postures/movements
3
Q
What are the symptoms of neuropathic pain?
A
- history of nerve injury, pathology or mechanical compromise
- pain referred in a dermatomal or cutaneous distribution
- pain/symptom provocation with mechanical/movement tests => move/load/compress neural tissue
- pain significantly higher with reduced QoL, different meds, prolonged diagnosis
4
Q
What are the symptoms of central sensitisation?
A
- pain disproportionate to nature of injury or pathology
- non-mechanical, unpredictable pattern of pain provocation
- no specific aggravating/easing factors
- diffuse/non-anatomical areas of pain/tenderness on palpation
- strong association with maladaptive psychosocial factors e.g. negative emotions
- occurs quickly in tissue injury but adaptive in short term => only chronic when maladaptive
5
Q
How is central sensitisation assessed?
A
- central sensitivity inventory
6
Q
How can patients fear affect pain modulation?
A
- fear about future of condition
- inherited beliefs about hurt = harm
- issues around controllability of pain
- management reflects compliance to ex + PHx
- therapists can reinforce by taking control
- ask patient to identify specific activities or goals => recovery related to high degree of flexibility in goal adjustment
7
Q
How can patients anxiety affect pain modulation?
A
- anxiety about their condition
- no clear explanation and prognosis
- heightened somatic awareness e.g. catastrophic thinking
8
Q
How can patients anger affect pain modulation?
A
- previously failed management => affect patients compliance with treatment
- attitudes of other about their condition
- socio-economic consequences of their pain
9
Q
How can patients depression affect pain modulation?
A
- associated limitation
- learned helplessness
10
Q
Where should patients go based on their type of pain?
A
- nociceptive = A&E/osteo/pain clinic e.g. nerve root irritation
- neuropathic pain = A&E/osteo/pain clinic e.g. nerve root irritation
- central sensitisation = A&E/osteo/pain clinic e.g. diabetic peripheral neuropathy
11
Q
Case Study:
- a 45 yo w/ 5 year history of LBP
- presents with antalgic posture, leg pain and ‘numbness’ in calf
- leg feels weak
- increasing frequency + intensity of episodes but lasting for less time
- has given up golf and sailing as a result
- Comes to you to put it back in
A
- neuropathic pain
- interferes with QoL
- neurological symptoms => increasing pain, frequency, intensity, leg weakness, antalgic posture
- adaptation of posture
12
Q
Case study:
- neuro testing reveals reduced reflex on right (at first but returns with treatment)
- SLR test negative
- mild reduction in pin-prick in lateral calf
A
- more peripheral sensitisation
- responds to treatment, only mild reduction in pin-prick sensitivity
- would ask about responding to heat/cold
13
Q
Give an example of nociceptive pain
A
- acute segmental strain, first ever episode
14
Q
Give an example of neuropathic pain
A
- nerve root irritation
15
Q
Give an example of central sensitisation
A
- 6 month history of intermittent LBP