Pain Mechanisms in Practice Flashcards

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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
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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
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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
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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
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5
Q

How is central sensitisation assessed?

A
  • central sensitivity inventory
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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
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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
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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
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9
Q

How can patients depression affect pain modulation?

A
  • associated limitation
  • learned helplessness
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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
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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
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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
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13
Q

Give an example of nociceptive pain

A
  • acute segmental strain, first ever episode
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14
Q

Give an example of neuropathic pain

A
  • nerve root irritation
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15
Q

Give an example of central sensitisation

A
  • 6 month history of intermittent LBP
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