PRELIMS: Pain Flashcards
Q: What is Myofascial Pain Syndrome (MPS)?
A: A chronic pain disorder caused by myofascial trigger points (MTrPs) that produce local and referred pain, sensory, motor, and autonomic symptoms.
Q: What are the main components of MPS?
A: Myofascial Trigger Points (MTrPs), tender spots, taut bands, muscle spasms.
Q: What are the most reliable criteria for diagnosing MTrPs?
A: Point tenderness, reproduction of symptoms on compression, local twitch response, painful restricted stretch, and muscle weakness without atrophy.
Q: What are the types of Myofascial Trigger Points (MTrPs)?
Primary MTrPs: Directly caused by muscle overload, injury, or postural stress.
Secondary MTrPs: Develop due to compensatory postures or muscle guarding.
Active MTrPs: Always painful, cause referred pain and functional impairments.
Latent MTrPs: Not painful at rest but become painful when palpated.
Q: What are common perpetuating factors of MPS?
A: Mechanical stress, nutritional deficiencies, metabolic/endocrine disorders, psychological factors, chronic infections, sleep disorders.
Q: What is the Integrated Hypothesis of Simons for MPS?
A: Tissue damage → Release of sensitizing substances → Motor endplate dysfunction → Excessive release of acetylcholine → Increased electrical endplate noise.
Q: What are the peripheral trigger point release techniques for MPS?
A: Needling, trigger point injections, steroids vs. local anesthetics vs. Botox, spray and stretch, deep striking massage.
Q: What are the central trigger point release techniques for MPS?
A: Paraspinal block, intramuscular stimulation, dry needling, manual spinal manipulation.
Q: What is Fibromyalgia Syndrome (FMS)?
A: A chronic pain disorder lasting >6 months with widespread musculoskeletal pain and multiple tender points.
Q: What are the diagnostic criteria for FMS according to ACR?
A: Pain for >3 months, widespread pain, tenderness at ≥11 of 18 tender points with 4 kg pressure.
Q: How does central sensitization contribute to FMS?
A: Increased substance P, NMDA receptor activation, decreased opioid responsiveness, and deficient descending pain inhibition.
Q: What are common conditions associated with FMS?
A: Irritable Bowel Syndrome (IBS), TMJ disorders, endometriosis, depression, anxiety, sleep disorders.
Q: What are the genetic factors linked to FMS?
COMT gene polymorphism affects pain tolerance.
Increased met/met genotype (low pain tolerance) in FMS patients.
Q: What are the common pharmacological treatments for FMS?
Pain Relievers: Tramadol, NSAIDs, COX-2 inhibitors, muscle relaxants.
Adjuvant Analgesics: Pregabalin, Gabapentin, Duloxetine, TCAs, SSRIs, SNRIs.
Sleep Modifiers: Zolpidem, Benzodiazepines, Trazodone.
Alerting Agents: Modafinil, Pramipexole.
Q: Why is exercise important in FMS management?
A: Helps improve function, reduce fatigue, increase strength, and prevent further deconditioning.
Q: What is the recommended non-pharmacological treatment for FMS?
A: Multimodal approach including exercise, cognitive-behavioral therapy, acupuncture, physical therapy, stress management, education.
Q: What is the best treatment strategy for FMS?
A: Start low, go slow; trial and error; multimodal approach; avoid unnecessary opioids; focus on lifestyle changes.
Q: Which pain fiber type is responsible for chronic, burning pain?
A: C fibers (slow, unmyelinated, poorly localized pain)
Q: What are the two main types of pain fibers?
A-delta fibers → Fast, sharp, localized pain (myelinated)
C fibers → Slow, dull, aching pain (unmyelinated)
Q: What is the main pain pathway in the spinal cord?
A: Spinothalamic tract (STT) → Carries pain signals to the brain
Q: What is the Gate Control Theory of Pain?
Pain can be blocked by activating A-beta fibers (touch, vibration), which stimulate inhibitory interneurons in the spinal cord, “closing the gate” to pain signals.
Q: What is an example of the Gate Control Theory in real life?
A: Rubbing an injured area reduces pain because A-beta fibers activate inhibitory neurons, blocking pain from A-delta & C fibers.
Q: Which pain pathway is responsible for emotional responses to pain?
A: Spinoreticular tract (involved in pain-related emotions and autonomic responses)
Q: How does the brain reduce pain through descending pathways?
Periaqueductal Gray (PAG) & Rostral Ventromedial Medulla (RVM) release serotonin & norepinephrine, which inhibit pain transmission.
Endorphins & opioids also block pain signals.
Q: Which neurotransmitters help reduce pain in descending pathways?
A: Serotonin, norepinephrine, and endogenous opioids (endorphins, enkephalins, dynorphins)
