Pain Syndromes Flashcards
centralized pain, widespread accompanied by fatigue, seep, memory or mood changes
nocioplastic pain
caused by irritation of the annulus, disc infection, herniation
discogenic pain
irritation of a nerve root due to a herniated nucleus pulposus or degenerative neuroforaminal narrowing.
radicular pain usually at L4-L5, L5-S1, C5-C6, C6-C7
How does radiculopathy affect LMN?
change sensation, weakness, decreased reflex
What causes spinal stenosis?
calcified ligamentum flavum or herniation. Distinguish with an MRI
What are surgical treatments of spinal stenosis?
Laminectomy or foraminotomy. If laminectomy and take out 3 or more laminas then the do the fusion.
What worsens/betters neurogenic claudication?
Worsened with:increased abdominal pressure,extension – Prolonged standing or walking,
Better with : flexion(“shopping cart” sign), - increases the anteroposterior diameter of thecentral canal.
When to order LP wuth headache?
neck pain, stiffness and fever
describes a wave neuronal depolarization in the cortical gray matter followed by neuronal activity suppression, resulting in blood flow changes
Cortical spreading depression MOA
Plexus of fibers from trigeminal ganglion in the right cerebral arteries, venous sinuses and dural matter resulting in painful neurotransmitter release
Neurovascular theory
Intracranial vasoconstriction results of ischemia and then causes the aura prior to migraines.
vascular theory
prevent migraines with …
BB, antiepileptic, TCA, gabapentinoids, Ca blockers
and more aerobics
ssociated with stress/anxiety/depression/poor posture
Pericranial tenderness induced by palpation is a hallmark feature of TTH
Tension headache
Cluster headache 9usually smokers and insane painwith lacrimation, sweating), paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua
Trigeminal autonomic cephalalgias
Treatment for cluster headache
intranasal lidocaine, O2
compression of TGN in artery, possible demyelination, reentry amplification
trigeminal neuralgia
treatment for TGN neuralgia
carbamazepine
A vascular HA caused by granulomatous inflammation of large and medium-sized cranial vessels that originate directly from the temporal artery
Giant cell arteritis
Why do you need to quickly diagnose giant cell arteritis?
prevent blindness secondary to anterior ischemic optic neuritis
What happens in centralizied sensitization that causes neuropathic pain?
inhibitoryinterneuronsnormallyareexcited byperipheralinput,attenuation of thisinput willdecreaseinhibition andamplify the painsignal.
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
neurapraxia
focal demyelination and axonal damageleading towalleriandegeneration.Axonalregeneration andreinnervation are required for recovery,which may occur spontaneously or require surgery.
axonotmesis
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
neurotmesis
What are symptoms of carpal tunnel?
paresthesias, dysesthesias, with tingling in the “m” fingers
compressionof the ulnar nerve as it passes between the medialepicondyle and the olecranon.
Cubital Tunnel Syndrome
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.
Tarsal Tunnel syndrome
Trauma, lithotomy (stirrups position), squatting
Foot drop due to weakness of the DF/eversion, sensory loss along the anterolateral shin and dorsum of thefoot.
peroneal neuropathy
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
meralgia paresthesia
Most affected nerves by herpes zoster
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
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
centralized/nociplastic pain
treatment for fibramyalgia
flexeril or tricyclic antidepressants good because they also help with sleep
Difference between CRPS type 1 and type 2
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
Possible MOA of CRPS
thought to be Beta adrenergic sensitization due to loss myelin from injury, or neurons alter excitability of others (ephaptic transmission)
