Pain Types and Presentation Flashcards
Peripheral Somatic Pain Definition
pain associated with actual or threatened damage to peripheral somatic structures
Peripheral Somatic Pain Features
well defined area of pain
clear history
clear anatomical patterns and boundaries
appropriate level of irritability for healing stage
clear stimulus response relationship
loading response make biomechanical sense
has a position of ease
reasonable stable
back pain main problem
deep,aching pain
well localised
pain can become sharp and cathing
referred pain often less severe - does not go beyond the knee, not TOP, dull pain, does not move
Peripheral Somatic Pain categories
benign specific spinal pathology acute severe pain impaired mobility impaired control - tight control impaired control - loose control
Benign Specific Spinal Pathology
specific back pain that is not a serious medical condition
spondylosthesis or pars articularis fracture
treatment guided by state of tissue health
Acute Severe Pain
pain dominant presentation - severe, acute and irritable
treatment is to modulate pain
Impaired Mobility
motion is excessively passively constrained lack of motion into the provocative direction result of issues with passive elements of the motion segment - older age - less episodic - less variation in symptom intensity - slower to resolve when aggravated - less intense - associated with stiffness - morning pain - relief with stretching - pain with position change - relief with stretching - less pain when warmed up - observed lack of mobility
Impaired Control - loose control
motion is insufficiently constrained movement is excessive into provocative directions usually result of problem with muscle performance within the lumbar spine - younger age - episodic - tends to be mroe intense - quicker resolution of severe pain - aggravated by minimal perturbations - aggravated by sudden or unguarded movements - describe feeling of being immobilises - feeling of giving way - back goes into spasm - catch or painful arc - post trauma or pregnancy
Impaired Control - tight control
motion is excessively actively constrained
movement appears to be restricted
result of problems with the active elements of the motion segment
pain with flexion and coming out of flexion
pain during static, mid range loading tasks
- various ages
- less episodic
- mid-range pain
- pain with static loading
- pain with flexion
- relief with distraction and relaxation
- describe tightness and tiredness
- burning pain
- fearful and anxious - anticipate pain
- breath holding
- excessive bracing or holding of the spine in the opposite direction
Peripheral Neurogenic Pain Definition
pain that is associated with a lesion or disease of the peripheral somatosensory nervous system
Peripheral Neurogenic Pain Features
well defined area of pain clear history clear anatomical patterns and boundaries appropriate level of irritability for healing stage clear stimulus response relationship loading response make biomechanical sense reasonably stable has a position of ease NERVE TRUNK PAIN - deep, aching - pulling pain - dragging pain - heaviness - along line of the nerve - tension point pain - linking up of pains neuroanatomically DYSAESTHETIC PAIN - sharp, shooting, stabbing - burning, gripping - along the sensory distribution of the nerve - paraesthesia - anaesthesia - weakness - hyperalgesia - allodynia - latent pain - after pain - feel wearing - peripheral tenderness
Peripheral Neurogenic Pain Types
radicular pain with radiculopathy
radicular pain only
Radicular Pain with Radiculopathy
dysaesthetic and nerve trunk pain dermatomal distribution neuroanatomical distribution associated symptoms - paraesthesia, anaesthesia etc. stretch sensitive compression sensitive positive NDT positive neural palpation positive neural integity local hyperalgesia
Radicular Pain only
nerve trunk only in neuroantaomical distribution minimal dysaesthesis no/minimal associated symptoms - weakness, paraesthesia etc. stretch sensitive not very compression sensitive positive NDT varied neural palpation negative neural integrity less common local hyperalgesia
Nociplastic Pain Definition
Input mechanisms have less impact on the pain experience. Mainly driven by changes within central nociceptive pathways and by the scrutinisation of information by the individual
Nociplastic Pain Features
sustained high levels of pain non-standard clinical course widespread pain extensive spreading of pain from the original area pain moves around spontaneous pain non-noxious triggers distorted stimulus-response relationship non restorative sleep extreme fatigue difficulty concentrating varied treatment responses hyperalgesia allodynia pain changes along with mood catastrophisation negative perceptions and expectations unhelpful behaviours - withdrawal form activity, social withdrawal, heavy drug and alcohol dependency
