Peds pain

Question 1

2016 ACR diagnostic criteria for fibromyalgia (not specific for juvenile fibromyalgia).

Answer 1

Widespread Pain Index (WPI) >6 and Symptom Severity Scale (SSS) >4 or WPI 4-6 and SSS >8. Pain in 4/5 regions. Symptoms present for more than 3 months.

Question 2

Types of CRPS

Answer 2

I- absence of nerve injury

II- causalgia- presence of nerve injury

Question 3

Therapy techniques for CRPS

Answer 3

Functional restoration: gradual progression from AROM to weight bearing, increasing aerobic activity, mirror therapy, desensitization techniques and propioceptive feedback.

Question 4

Medication overuse headache

Answer 4

rebound headache associated with the overuse of headache medication for more than half of the month, or takes multiple medications more than 10 times per month.

Question 5

CRPS criteria

Answer 5

Budapest criteria
Must report at least one symptom in three of the four following categories and Must display at least one sign at time of evaluation in two or more of
the following categories:
• Sensory: hyperesthesia and/or allodynia.
• Vasomotor: temperature asymmetry and/or skin color
changes and/or skin color asymmetry.
• Sudomotor/Edema: edema and/or sweating changes
and/or sweating asymmetry.
• Motor/Trophic: decreased range of motion and/or motor
dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin).

Question 6

Criteria for hEDS

Answer 6

Beighton criteria, score of
>5 prepubertal, >4 pubertal
+ connective tissue disorder and family history.

Question 7

Low dose naltrexone mechanism action

Answer 7

At low doses (1/10) compared to as an opioid R antagonist at 50mg, has an antagonist effect on non-opioid R, Toll-like Receptor 4 (TLR4). TLR4 is found in microglia which produces inflammatory factors.

Question 8

POTS

Answer 8

Postural Orthostatic Tachycardia Syndrome (POTS): Sustained orthostatic tachycardia of more than 40 beats per minutes without hypotension associated with functional impairment and presyncopal episodes.May be associated with generalized pain, fatigue, poor sleep and hypermobility.

Question 9

Most common location for acute non crisis pain in SCD

Answer 9

long bones and low back

Question 10

Most common location for crisis pain in SCD

Answer 10

head, neck and chest

Question 11

Medication for prevention of acute vaso-occlusive SCD crises

Answer 11

Hydroxyurea: potent inducer of fetal hemoglobin

Question 12

Management for acute pain in SCD

Answer 12

Opioids

Question 13

Psychologic intervention to manage chronic pain

Answer 13

Cognitive Behavioral therapy- CBT