Pain Syndromes

Question 1

centralized pain, widespread accompanied by fatigue, seep, memory or mood changes

Answer 1

nocioplastic pain

Question 2

caused by irritation of the annulus, disc infection, herniation

Answer 2

discogenic pain

Question 3

irritation of a nerve root due to a herniated nucleus pulposus or degenerative neuroforaminal narrowing.

Answer 3

radicular pain usually at L4-L5, L5-S1, C5-C6, C6-C7

Question 4

How does radiculopathy affect LMN?

Answer 4

change sensation, weakness, decreased reflex

Question 5

What causes spinal stenosis?

Answer 5

calcified ligamentum flavum or herniation. Distinguish with an MRI

Question 6

What are surgical treatments of spinal stenosis?

Answer 6

Laminectomy or foraminotomy. If laminectomy and take out 3 or more laminas then the do the fusion.

Question 7

What worsens/betters neurogenic claudication?

Answer 7

Worsened with:increased abdominal pressure,extension – Prolonged standing or walking,
Better with : flexion(“shopping cart” sign), - increases the anteroposterior diameter of thecentral canal.

Question 8

When to order LP wuth headache?

Answer 8

neck pain, stiffness and fever

Question 9

describes a wave neuronal depolarization in the cortical gray matter followed by neuronal activity suppression, resulting in blood flow changes

Answer 9

Cortical spreading depression MOA

Question 10

Plexus of fibers from trigeminal ganglion in the right cerebral arteries, venous sinuses and dural matter resulting in painful neurotransmitter release

Answer 10

Neurovascular theory

Question 11

Intracranial vasoconstriction results of ischemia and then causes the aura prior to migraines.

Answer 11

vascular theory

Question 12

prevent migraines with …

Answer 12

BB, antiepileptic, TCA, gabapentinoids, Ca blockers
and more aerobics

Question 13

ssociated with stress/anxiety/depression/poor posture
Pericranial tenderness induced by palpation is a hallmark feature of TTH

Answer 13

Tension headache

Question 14

Cluster headache 9usually smokers and insane painwith lacrimation, sweating), paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua

Answer 14

Trigeminal autonomic cephalalgias

Question 15

Treatment for cluster headache

Answer 15

intranasal lidocaine, O2

Question 16

compression of TGN in artery, possible demyelination, reentry amplification

Answer 16

trigeminal neuralgia

Question 17

treatment for TGN neuralgia

Answer 17

carbamazepine

Question 18

A vascular HA caused by granulomatous inflammation of large and medium-sized cranial vessels that originate directly from the temporal artery

Answer 18

Giant cell arteritis

Question 19

Why do you need to quickly diagnose giant cell arteritis?

Answer 19

prevent blindness secondary to anterior ischemic optic neuritis

Question 20

What happens in centralizied sensitization that causes neuropathic pain?

Answer 20

inhibitoryinterneuronsnormallyareexcited byperipheralinput,attenuation of thisinput willdecreaseinhibition andamplify the painsignal.

Question 21

compression or stretch injury affecting the myelin sheath without damaging the nerve. Conduction is intact both proximal and distal to, but delayed the site of injury.Leads to temporary sensorimotor deficits distal to that site that resolve over time

Answer 21

neurapraxia

Question 22

focal demyelination and axonal damageleading towalleriandegeneration.Axonalregeneration andreinnervation are required for recovery,which may occur spontaneously or require surgery.

Answer 22

axonotmesis

Question 23

complete transection of all neural structures, including the axon and itsconnective tissue. Without intact connective tissue elements, there canbe no organized regeneration and surgical intervention is required

Answer 23

neurotmesis

Question 24

What are symptoms of carpal tunnel?

Answer 24

paresthesias, dysesthesias, with tingling in the “m” fingers

Question 25

compressionof the ulnar nerve as it passes between the medialepicondyle and the olecranon.

Answer 25

Cubital Tunnel Syndrome

Question 26

tibial nerve as it passing under the flexor retinaculum at the medial malleolus.
numbness and pain in the sole of the foot that spares the heel.

Answer 26

Tarsal Tunnel syndrome

Question 27

Trauma, lithotomy (stirrups position), squatting
Foot drop due to weakness of the DF/eversion, sensory loss along the anterolateral shin and dorsum of thefoot.

Answer 27

peroneal neuropathy

Question 28

entrapment mononeuropathy of the lateral femoral cutaneous nerve. Caused by compression under the inguinal ligament near the ASIS.

Predisposing factors include tight waistbands, seat belts, tool belts), obesity, pregnancy, rapid weight changes, inguinal hernia repair, cesarean section, renal transplantation, and hip surgery

Answer 28

meralgia paresthesia

Question 29

Most affected nerves by herpes zoster

Answer 29

most affected nerves follow this order: thoracic, ophthalmic division of the TG nerve (V1), maxillary division (V2), cervical spinal roots, and sacral spinal root. Use gabapentin for the pain

Question 30

deafferentation” pain that can result from any lesion found in the CNS
demyelinating, vascular, infectious, inflammatory, and traumatic
Pain onset may be delayed by several months after the initial insult, reflecting the slow degeneration process within the CNS

Answer 30

centralized/nociplastic pain

Question 31

treatment for fibramyalgia

Answer 31

flexeril or tricyclic antidepressants good because they also help with sleep

Question 32

Difference between CRPS type 1 and type 2

Answer 32

type I has unclear cause
type II:
presence of a defined nerve injury
CRPS is more common in women > men, incidence reaches its peak in 50’s,
It involves one limb in most case

Question 33

Possible MOA of CRPS

Answer 33

thought to be Beta adrenergic sensitization due to loss myelin from injury, or neurons alter excitability of others (ephaptic transmission)