PBL 2 Flashcards
Describe lancinating pain
this is characterised by piercing or stabbing sensations – indicative of nerve irritation
describe paracetamol
this is also known as acetaminophen, it is a medication that is used to treat pain and fever, typically used for mild to moderate pain relief
describe ibuprofen
medication in the nonsteroidal anti-inflammatory drug class that is used for treating pain, fever and inflammation
describe diclofenac
this is a nonsteroidal anti-inflammatory drug used to treat pain and inflammatory diseases such as gout
describe tramadol
– this is an opioid pain medication used to treat moderate to moderately severe pain
define amitriptyline
Tricyclic antidepressant
- this is often prescribed in neuropathic pain at low doses
define pregabalin
anticonvulsant (anti-epileptic) drug prescribed for many forms of neuropathic pain
what are the risk factors of back pain
- age
- lack of exercise
- excess weight
- diseases
- improper lifting
- psychological conditions
- smoking
what does our patient have
x
where would have the disc prolapsed taken place
- Pain felt in L5 as it radiates down to the big toe, suggests herniation in the L4/L5 region as the L5 nerve leaves below the L4/L5 disc
describe the Analgesic ladder
- Non-opioids (e.g. aspirin, paracetamol, NSAID) and adjuvant.
- Moderate efficacy opioids (e.g. codeine)
• +/- non-opioids and adjuvant theraphy. - High efficacy opioids (e.g. morphine)
+/- non-opioids and adjuvant theraphy
How does acupuncture work
- Stimulates DNIC (Diffuse noxious inhibitor controls) and this supresses pain transmission in neurones of the dorsal horn, reductions A delta and C fibres transmission
Mechanism
• Nociceptors active when pins are pushed in.
• It activates descending inhibitory neurons in the brainstem reticular formation (PAG, raphe nuclei and locus Coeruleus).
How does physiotherapy lessen the pain
- Muscles need to be loosened and stretched, and this will lessen the pain through increasing blood flow as well as decreasing inflammation.
- Exercises will break down scar tissue and allow it to regain its normal flexibility.
- Advice given on improving strength of musculature/maintaining good posture to avoid strain.
= during the first stages of physiotherapy it may irritate the muscles therefore ice and heat treatments needs to be used alongside
How does transcutaneous electrical nerve stimulation work
: analgesia can be produced by stimulating non-noxious afferents. These also stimulate lamina II interneurons.
what does Jerry experience
- he experiences two episodes of pain and these both have a different cause
- the first one is inflammatory acute pain and the second one is neuropathic pain
Specifically, Jerry initially has radicular pain that develops into chronic neuropathic pain condition.
What is inflammatory acute (Nociceptive) pain caused by
= may be caused by a strained muscle (or other soft tissue injury) ligamentous sprain or weakness in a disc relating to back pain itself.
• This type of pain is treatable and reversible.
How is the nociceptive pain treated in the scenario
o In scenario, pain is reduced by NSAIDs and paracetamol.
What is neuropathic pain due to
pain arising as a direct consequence of lesion/disease affecting the somatosensory system.
What is radicular pain
This is pain that radiates along a dermatome of a nerve due to irritation of the nerve root at the spinal cord
What are the most common causes of radicular pain
o Spondylitis/spondylosis (arthritis affecting the joints)
Spinal nerve leaving foramen damage by inflamed joints.
o Herniated Intervertebral Disc (related to degenerative conditions of the spine).
Nerve root/sensory ganglion compression/irritation.
What is spondylitis
arthritis affecting the joints
where do nerve roots exit the spinal cord
- nerve roots exit the spinal cord below there respective veretebrae
Where are nerve roots most vulnerable
• Most vulnerable to lateral root herniation just above their exit intervertebral foramina because they are the most anterior and lateral in the vertebral canal
describe the frequency of herniation of the L5 and S1 spinal roots
L5 spinal root = exits below the L4/L5 disc.
• Most frequent herniation (50%)
S1 spinal root = exits below the L5/S1 sic
• Less frequent herniation (45%).
What is Jerrys pain as a result of compression of which nerve
- Jerry has pain down L5 - down the side of this left leg across the top of his foot and onto his big toe which indicates L5 injury
- therefore there could have been a disc herniation at the level of L4/L5
what is the difference between radicular pain and sciatica pain
Radicular pain - this is pain that goes down the front of the leg and follows L5
Sciatica - this is pain that goes down the back of the leg and onto the Botton of the foot it follows S1
What does neuropathic pain a result of
• Neuropathic pain occurs due to the maladaptation of the nervous system wherein firm pain is perceived despite there being no stimuli that are associated with ongoing injury.
What is the explanation of why the intimal pain is localised to the back and buttocks
- initially localised then it will spread due to central and peripheral sensitisation
- this is because in response to acute nociceptive pain there will be an inflammatory reaction.
• Inflammation = increases pain.
describe peripheral sensitisation
• Because of inflammatory mediators (such as prostaglandins), nociceptive sensory neurons have:
o A reduction in activation threshold.
o Increased responsiveness (more sensitive).
• Hyperalgesia: perception of painful stimuli is increased.
What is hyperalgesia
• Hyperalgesia: perception of painful stimuli is increased
describe central sensitisation
• Noxious inputs drive changes in the spinal cord that allow non painful inputs to access the pain pathway to perception (decrease in activity threshold).