Psychiatry-Pain Flashcards
What is the difference between psychogenic pain and idiopathic pain?
Psychogenic: pain contradicts everything we know about neuroanatomy. Idiopathic: pain from unknown or obscure cause
What is the difference between acute and chronic pain?
Acute < 6 months and hurt = harm. Chronic > 6 months and rehab is the goal.
What is the cure for chronic pain?
There is no cure. It must be managed via the biopsychosocial model.
How does the traditional model of pain compare to the biopsychosocial model of pain?
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What are some reasons clinics try to manage pain without the use of opioids?
Abuse, low efficacy, side effects, hyperalgesia & death
A patient comes to see you in the pain clinic complaining of chronic low back pain that has lasted for several years. You put him on opioids for short-term pain management, but his pain gets worse as you increase the dose. What is this called?
Opioid-induced hyperalgesia due to pathologic activation of NMDA receptors
What are first line medications for Neuropathic pain?
TCAs (Nortriptyline, desipramine), SNRIs (Duloxetine, venlafaxine), Ca channel modulators (gabapentine, pregabalin) and topical lidocaine
2nd and 3rd line medications for neuropathic pain?
Tramadol, opioids, SSRIs, buprion, antiepileptics and NMDA antagonists
What psychotherapy method has the best evidence in treating chronic pain?
Cognitive behavioral therapy to break the cycle seen below.
What criteria must be met for a patient to be diagnosed with somatic symptom disorder?
1) One or more distressful symptom that disrupts normal life 2) Excessive thought, feelings or behaviors about the symptom 3) 6 months duration 4) Specify for individuals whose symptom is primarily pain
What distinguishes illness anxiety disorder from somatic symptom disorder?
The patient is preoccupied with an illness but symptoms are not really present
What is the diagnosis in a patient who has anxiety symptoms that exacerbate a present medical condition that are not better explained by another mental disorder?
Psychological Factors Afxfecting Other Medical Conditions
