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MSK Exam 1 - Spring > Pain Phenotyping - Done > Flashcards

Pain Phenotyping - Done Flashcards

1
Q

What is pain phenotyping?

A

Set of observable pain characteristics of an individual resulting from the interaction between the body and the environment

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2
Q

What is nociceptive pain?

A

Non-nervous tissue compromise

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3
Q

What two categories is nociceptive pain broken into?

A
  • MSK: including spondylogenic
  • Viscerogenic
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4
Q

What is neuropathic pain?

A

Nervous tissue compromise

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5
Q

What three categories is neuropathic pain broken into?

A
  • Radicular
  • Radiculopathy
  • Terminal Nerve Branch Neuropathy
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6
Q

What is nociplastic pain?

A

Altered pain perception without complete evidence of actual or threatened tissue compromise

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7
Q

What kind of pain produces local as well as referred symptoms from the involved spinal structure?

A

Spondylogenic

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8
Q

What is spondylogenic pain?

A
  • Pain from the spine
  • It is common
  • Local and/or referred spinal pain from noxious stimulation of spinal structures
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9
Q

Can spondylogenic pain cause visceral dysfunction?

A

CANNOT cause visceral dysfunction as some providers claim

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10
Q

Is spondylogenic pain segmental or nonsegmental?

A

Nonsegmental

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11
Q

What is a segment?

A

Two vertebrae and its spinal nerve… ex: L4-L5 and nerve between

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12
Q

How would someone describe spondylogenic pain?

A

Deep, achy, boring, and vague

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13
Q

With spondylogenic pain will you have neuro findings?

A

No, they are WNL

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14
Q

Is spondylogenic pain entirely reproducible?

A

Not entirely

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15
Q

With spondylogenic pain you have somatic convergence or referred pain. Because of this, you have sensory afferent nerves that _____ on a _____ same innervation.

A

converge, shared

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16
Q

With spondylogenic pain which do you have a greater referral of pain from? Proximal and deep structures or distal and superficial structures?

A

Proximal and deep

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17
Q

Why would you get more pain referrals from proximal and deep structures with spondylogenic pain?

A

The spinal facets are able to refer more than say a knee joint or a hip joint

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18
Q

What are symptoms of spondylogenic pain?

A
  • Non-segmental pain
  • Rarely if any paresthesias
  • Vague, deep, achy, and boring pain
  • Referred into a vague area due to somatic convergence that settles into a consistent location
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19
Q

What are signs of spondylogenic pain?

A
  • Neuro scan WNL
  • Can’t reproduce entire symptom pattern with motion
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20
Q

Where will you find spondylogenic pain in the thoracic spine?

A

Wraps around the respective vertebral levels with overlap in the trunk

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21
Q

Where will you find spondylogenic pain in the lumbar spine?

A
  • MOST often in the gluteal region and proximal thigh
  • May go as far as the foot
  • Inconsistent pattern between individuals
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22
Q

Are spondylogenic pain symptoms from a compromised spinal nerve?

A

No, and your neuro test will show you that since they are WNL

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23
Q

What is viscerogenic pain?

A

Referred pain from an organ

24
Q

What is viscerosomatic convergence?

A

Viscera and somatic (body) sensory afferents converge on and share the same innervation

25
Q

How might someone describe a viscerogenic pain?

A

Vague, deep, achy, and boring pain

26
Q

What is an example of referred viscerogenic pain?

A

Kidneys can refer into the T10-L1 dermatomes

27
Q

What are the signs and symptoms of viscerogenic pain?

A
  • Not typically able to be mechanically reproduced
  • Neuro scan WNL
28
Q

What is radicular pain?

A

Ectopic or abnormal discharge from highly inflamed dorsal root of spinal nerve

29
Q

What are symptoms of radicular pain?

A

Lancing, electrical shock-like pain along an extremity in a narrow 2-3” band

30
Q

What are signs of radicular pain?

A
  • Dermatoms, DTRs, and Myotomes likely WNL: may be difficult to localize segment if acute/mild; it takes time for hypo-activity to show
  • (+) Neurodynamic mobility tests due to HIGH inflammation
  • NOT common
  • Imaging helpful for involved spinal nerve
31
Q

What is radiculopathy?

A

Blocked conduction of spinal nerve due to compression and/or inflammation

32
Q

What are symptoms of a radiculopathy?

A
  • Segmental paresthesias that are often constant and long-duration
  • Segmental paresthesias that have a slow progression to a vague area due to dermatomal overlap
33
Q

What are signs of radiculopathy?

A
  • Neuro scan (+) for spinal nerve hypoactivity
  • Imaging helpful for involved spinal nerve
33
Q

What is terminal nerve branch pain?

A

Decreased conduction of the terminal nerve branch

34
Q

What are symptoms of terminal nerve branch pain?

A
  • Non-segmental paresthesias that are often intermittent and short-duration
  • Non-segmental paresthesias that have a fast progression to a well-defined area of numbness because of minimal sensory overlap of terminal nerve branch (unlike spinal nerve)
  • Possible weakness
35
Q

What are signs of terminal nerve branch pain?

A
  • Dermatomes, DTRs, and myotomes WNL
  • Non-segmental terminal nerve branch hypoactivity that leads to decreased sensation along terminal nerve branch distribution and possible weakness of muscle innervated by terminal nerve branches
  • (+) neurodynamic mobility tests
36
Q

What is nociplastic pain?

A
  • Defined as altered pain perception without complete evidence of actual or threatened tissue compromise
  • initial term of sensitization pain in 2010
  • Current term originated in 2017
  • Signs and symptoms of sensitization are present within nociplastic pain
  • Sensitization is an underlying mechanism
  • Patients with sensitization are labeled as having nociplastic pain
37
Q

What is the pathogenesis of nociplastic pain?

A
  • Thinning of myelin sheath
  • Increased sensitivity and
    misinterpretation by peripheral nociceptors
  • Persistent excitation of A-delta
    and C fibers
38
Q

What sensation do A-delta and C fibers carry?

A
39
Q

Persistent excitation of A-delta and C fibers inhibit what?

A

Inhibits larger myelinated A-beta fibers pre-synaptically making it harder to override P! with motion

40
Q

When there is an increased sensitivity and misinterpretation by CENTRAL structures what happens?

A
  • Increased excitability of segmental dorsal horn neurons
  • Lower synaptic resistance so P! sensations occur easier
41
Q

A loss of descending anti-nociceptive mechanisms causes what?

A
  • Less endogenous opiates released
  • Less P! control
42
Q

Why can symptoms “spread”
with nociplastic pain?

A

Somatic Convergence: Shared areas of innervation share symptoms; think of spondylogenic and referred pain

43
Q

What is somatic convergence?

A
  • C-fibers that transmit pain, split, and travel at least 2 spinal segments superiorly and inferiorly
  • Ex: persistent symptoms with L4, 5
    hypermobility/instability can eventually spread and create symptoms through the entire LQ (L2-
    S2)… Like a domino effect
44
Q

With somatic convergence, the brain perceives the pain as coming from where?

A
  • Even more areas with persistent symptoms… its a downward spiral
  • Brain homunculus “smudged”
45
Q

What functional questionnaires can you use for nociplastic pain?

A
  • Central Sensitization Inventory
  • Neurophysiology of Pain Test: to assess fear avoidance, catastrophizing, understanding
  • Regional specific
46
Q

What is the prevalence of nociplastic pain?

A

A growing number of conditions such as:
- Migraine
- Neck pain: traumatic and non-traumatic
- Shoulder pain
- Lateral elbow pain
- LBP
- Age-related Joint Changes
- Persistent fatigue syndrome
- Fibromyalgia

47
Q

What is the criteria for possible nociplastic pain?

A
  • ≥ 3 months of pain
  • Regional or spreading symptoms
  • Pain that cannot be entirely explained by nociceptive or neuropathic pathways
  • Pain hypersensitivity or allodynia (non-painful stimuli causing pain)
48
Q

What is the criteria for probable nociplastic pain?

A
  • The addition of any of the
    following comorbidities to “possible”
    criteria
  • Sensitivity to sound, light, and/or odor
  • Sleep disturbances
  • Fatigue
  • Cognitive problems
49
Q

What kind of benefit do JM have on nociplastic pain?

A
  • Theoretical benefits on symptoms
  • MOST accepted- stimulates descending inhibitory pain mechanisms i.e., MORE endorphins
50
Q

Do JM induce or reduce presynaptic inhibition in nociplastic pain?

A
  • Induces presynaptic inhibition
  • Limit pain transmission by A-delta and C fibers
  • Better overriding of pain by A-beta stimulation
51
Q

What can JM reduce in nociplastic pain?

A
  • Reduces dorsal horn excitability
  • Decreases inflammatory mediators
52
Q

What should METs look like for nociplastic pain?

A
  • Low to moderate global aerobic and resistance activities
  • 2-3x/wk.
  • 30-90 minutes per session
  • At least 7 weeks duration
  • Endogenous/opiate analgesia
  • Helps pt. to interpret pain and motion as non-threatening
  • Reorganizes Homunculus
53
Q

Why is neuroscience education/behavioral therapy important for pts with nociplastic pain?

A
  • Not just mind over matter
  • Explain increased sensitivity and misinterpretation to reduce stress/anxiety of misperceived tissue
    injury
  • Challenge the patient’s reasoning of fears
  • Ensure the safety of exercise
  • Transition to adaptive pain coping
54
Q

What is the prognosis for someone with nociplastic pain?

A
  • Varying degrees of improvement
  • Longer recovery
  • Likely not a full resolution of symptoms

MSK Exam 1 - Spring (9 decks)

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