pain types Flashcards
list fibres responsible for nociception
A delta fibres - mechanical fast well localised sharp pricking pain, have glutamate neurotransmitter
C fibres - polymodal slow pain, diffuse, dull aching, burning, substance P neurotransmitter
hyperalgesia
increased pain from a stimulus that normally provokes pain
difference for primary and secondary hyperalgesia
primary hyperalgesia - increased sensitivity to input at the site of the injury and due to processes in damaged tissues. It is largely due to the sensitisation of peripheral nociceptors.
secondary hyperalgesia - sensitivity in uninjured tissues around the original injury. This is most likely to arise from central mechanisms.
allodynia
pain evoked by stimuli that are not normally painful
neuropathic pain
Pain caused by a lesion or disease of the somatosensory nervous system.
peripheral neuropathic pain
Pain caused by a lesion or disease of the peripheral somatosensory nervous system.
central neuropathic pain
Pain caused by a lesion or disease of the central somatosensory nervous system.
nociplastic pain
Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.
central sensitization
Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.
peripheral sensitization
Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields.
pathophysiology of central sensitisation
neurons in spinal cord become hypersensitive to stimuli from involved tissue
increase their response to noxious and innocuous stimuli from remote uninvolved tissue
sprouting of A fibres in dorsal horns - develop new synaptic connection with nociceptor system
WDR range cells in dorsal horn becomes sensitised
features of nociceptive pain
typically short lasting, stimulus-response couples
Dull, deep, aching type pain.
Mechanical / physiological processes in injured tissue: tends to be localised.
Predictable response to stretch, compression or movement
definition of nociceptive pain
pain that arises from actual or threatened damage to non neural tissue and is due to the activation of nociceptors. Used to describe pain within normally functioning somatosensory nervous system
management strategies of nociceptive pain
Responds to simple painkillers & NSAIDs
Improves with appropriate passive vs active management (manual) treatment
definition of inflammatory nociceptive pain
considered under the term nociceptive pain, inflammatory pain can be associated with acute tissue damage, infection or active inflammatory conditions e.g. RA.
Management implications of inflammatory nociceptive pain
manage pain to enable increased activity without pain flares
respond to simple analgesia
require biologics DMARDs for specific inflammatory processes
neuropathic pain definition
pain caused by lesion or disease of the peripheral somatosensory nervous system.
features of neuropathic pain
atypical verbal descriptors e.g. tingling, burning, stabbing, electrical shocks
paraesthesia and possible muscle weakness
allodynia
provoked by neurodynamic test, compression ro nerve palpation
response to passive treatment varies
pain referred in a dermatomal distribution
examples of neuropathic pain
shingles
cervical or lumbar radiculopathy
neuritis
neuroma
phantom limb pain
trigeminal neuralgia
management implications
manual treatments readily provoke symptoms
require specific pharmacological management
features of nociplastic pain
widespread non anatomical distrubtion
ongoing pain after healing with hyperalgesia allodynia
inconsistent response to stimuli and tests
pain meds ineffective and exacerbated by emotion
unpredictable response
discogenic LBP is an example of nociceptive, neuropathic or nociplastic pain?
nociceptive
radiculopathy is an example of nociceptive, neuropathic or nociplastic pain?
peripheral neuropathic or nociceptive or mixed
mechanical LBP is an example of nociceptive, neuropathic or nociplastic pain
nociceptive pain
how is sensitisation of a pain determined
how easily pain is triggered by the following stimuli;
movement
posture
load
palpation
sensory
stress
examples of neuropathic pain questionnaires
Self-LANSS
painDETECT
how is a patients disability assessed?
Oswestry Disability Index
pt asks questions on the following domains; pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, travelling, employment or homemaking.
answered using 5 choices on how difficult it is to fulfill the previously mentioned domains
40-60% = high level disability
20-40% = moderate level disability
0-20% = mild level disability
what tools can be used to assess the psychological aspect of a patients pain
Anxiety & Depression e.g. HADS
Beliefs & Attitudes questionnaires e.g. STarT Back tool, FABQ
Fear of movement e.g. Tampa Scale for Kinesiophobia
