Pain Types and Viscerogenic Pain Patterns

Question 1

What are the three proposed mechanisms for referred visceral pain?

Answer 1

• Embryological development
• Multisegmental Innervation
• Direct pressure and shared pathways

Question 2

Which of the three proposed mechanisms for referred visceral pain likely has a PRIMARY role in visceral pain patterns?

Answer 2

embryological development

Question 3

Does assessment or measurement of pain provide a more robust and full picture of a patient’s pain?

Answer 3

assessment (history, physical exam findings, medication Hx, functional status, psychosocial and spiritual factors.)

Question 4

Older adults often under-report or fail to report pain due to perceptions of reporting. Those include?

Answer 4

• Others perception
• Embarrassment
• Perceptions of exaggerated symptoms
• Fear avoidance
• Avoidance of medial settings
• Medications and treatment
• Cost

Question 5

This pain type is often described as ‘sharp, shooting, burning, tingling,’ is not alleviated by opiates or narcotics, but local anesthesia may give some relief

Answer 5

Neuropathic

Question 6

This pain type is due to unilateral stimulation of n. endings of somatic structures. It is often described as “dull, achy, gnawing, diffuse, and pressure.”

Answer 6

Somatic

Question 7

This pain type occurs when emotional or psychological distress produces physical symptoms

Answer 7

somatoemotional

Question 8

This pain type occurs when visceral structures affect the somatic musculature.

Answer 8

Viscero-somatic (ex: appendicitis causes rigid abdomen)

Question 9

This pain type occurs when myalgic conditions cause disturbance of underlying viscera

Answer 9

somatovisceral

Question 10

Deep somatic pain is associated with all of the following, EXCEPT:
a. “dull, achy”
b. autonomic phenomenon
c. good localization
d. periosteum, nerves, muscles, tendons, ligaments, blood vessels, cancellous bone, deep fasciae.

Answer 10

c. good localization

(Deep is poorly localized! Also responds to rest/NWBing and can refer to superficial structures)

Question 11

Superficial somatic pain is associated with all all of the following, EXCEPT:
a. May refer to deep structures.
b. Well localized, pin point, sharp pain
c. skin/subcutaneous tissue (cutaneous), superficial fasciae, tendon sheaths, periosteum
d. trophic changes

Answer 11

a. may refer to deep structures (associated with referred pain, not to deep structures)

Question 12

This pain type receives bilateral innervation causing “dull, achy, constant” pain not relieved with rest. Typically it is diffuse and poorly localized. If it refers - it does so in a dermatomal fashion. Pain is associated with inflammation/distention.

Answer 12

Visceral

Question 13

This pain type is well localized, but might have poorly defined borders. It may spread and radiate from point of origin.

Answer 13

Referred

Question 14

Nociceptive pain

Answer 14

Pain that arises from actual or threatened damage to non-neural tissue

Question 15

neuropathic pain

Answer 15

pain caused by a lesion or disease of the somatosensory nervous system.

Question 16

Nociplastic pain

Answer 16

pain in which no tissue damage is present to activate nociceptors or any other evidence of somatosensory disease.

Question 17

Nociceptive pain is caused from

Answer 17

activation of nociceptors (inflammation, mechanical irritant, injury)

Question 18

Neuropathic pain is caused from

Answer 18

lesion or disease of somatosensory system

Question 19

Nociplastic pain is caused from

Answer 19

central pain processing disorder

Question 20

Visceral tension

Answer 20

dissension of organ causing colicky waves of pain and tension

Question 21

Inflammatory pain

Answer 21

deep/boring pain with poor localization involving the viscera, and more well localized when involving the parietal peritoneum.

Question 22

Ischemic pain

Answer 22

due to loss of blood supply resulting in tissue death described as sudden, intense, constant, progressive, and non-responsive to analgesics.

Question 23

Types of Muscle pain

Answer 23

Muscle tension, spasm, trauma

Question 24

A musculoskeletal red flag indicating cancer or neurological impairment includes

Answer 24

proximal muscle weakness with a change in one or more DTRs.

Question 25

Trigger Point Characteristics

Answer 25

• Focal tenderness
• Referred regional pain
• Local twitch response

Question 26

Active trigger point

Answer 26

refers pain locally and to another location at rest.

Question 27

Latent trigger point

Answer 27

no pain at rest, can refer pain with applied pressure

Question 28

How do trigger points affect the viscera?

Answer 28

they can produce visceral symptoms w/o actual impairment or organ disease

Question 29

Some causes of systemic joint pain include

Answer 29

• Allergic reactions to medication
• Side effect of medication
• Delayed reaction to chemicals/environmental exposure
• Arthritis
• Autoimmune disorders
• Inflammatory Bowel Disease
  …and more!

Question 30

This type of pain is associated with a throbbing sensation, especially when systolic pressure is increased. Symptoms may worsen with recumbency.

Answer 30

Arterial pain

Question 31

This throbbing pain is worse with respiratory movements and symptoms may worsen with recumbency.

Answer 31

Pleural/tracheal

Question 32

This pain is related to eating or fasting/emptying of involved segment with vomit/BM, dissension of liver, kidney, spleen or pancreas, or gastric acid on esophagus, stomach or duodenum.

Answer 32

gastrointestinal pain

Question 33

Radicular pain or pain is due to irritation (or inflammation) of a spinal nerve/root.

Answer 33

radicular pain

Question 34

This type of pain is commonly poorly localizes, not well defined, and has an overly of emotional presence.

Answer 34

Chronic pain

Question 35

Central sensitization

Answer 35

increase responsiveness of nociceptive neurons in the CNS to their normal or sub threshold afferent input.

Question 36

Peripheral sensitization

Answer 36

increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields.

Question 37

Hyperalgesia

Answer 37

increased pain from a stimulus that normally provokes pain

Question 38

hyperesthesia

Answer 38

increased sensitivity to stimulation, excluding the special sense

Question 39

Sensitization

Answer 39

increased responsiveness of nociceptive neurons in the CNS to their normal or sub threshold afferent input.

Question 40

Fear avoidance behavior

Answer 40

anxiety, fear of pain and pain catastrophizing may lead to avoidance of physical +/- social activities.

Question 41

What are some potential screening tools for fear avoidance behavior?

Answer 41

fear avoidance beliefs questionnaire
Tampa scale for kinesiophobia
Pain catastrophizing scale

Question 42

What score indicates potential psychological symptoms associated with pain on the McGill pain questionnaire?

Answer 42

10 or above.

Question 43

Waddell’s Nonorganic signs help to identify

Answer 43

patients that need physical as well as psychosocial and behavioral management for low back pain

Question 44

Areas of assessment under Waddell’s Non-organic signs

Answer 44

Tenderness
Simulation
Distraction
Regional disturbances
Overreaction

Question 45

Conversion

Answer 45

sudden, acute physical expression (motor and sensory functional impairment) of unconscious psychological conflict.