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MSK/Derm > SM 250: Acute vs Chronic Pain > Flashcards

SM 250: Acute vs Chronic Pain Flashcards

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Dermatology Board Prep flashcards
1
Q

What is pain?

A

Pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage

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2
Q

What two factors classify pain?

A

Duration: acute vs chronic

Mechanism: nociceptive vs neuropathic

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3
Q

What types of pain stimuli can be detected by primary afferent neurons, and what fibers connect them to a dorsal root ganglion?

A

Non-noxious mechanical stimulus = Abeta fiber

Noxious mechanical stimulus = Adelta fiber

Noxious heat and chemical stimuli = C fiber

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4
Q

What structures are broadly involved in the Ascending pain pathway?

A

Spinothalmic Tract to Thalamus to Somatosensory Cortex and other areas of the brain

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5
Q

What role does the Thalamus play in the Ascending pain pathway?

A

The Thalamus is a relay station for pain signals

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6
Q

What is the function of the descending inhibitory pathway?

A

Downregulates pain signals being detected in the Ascending pain pathway from the periphery

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7
Q

How does the Descending Inhibitory Pathway modulate pain?

A

Inhibitory signals from the brain and spinal cord are relayed to the Dorsal Horn of the Spinal cord to limit incoming pain signals

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8
Q

How does the Descending Inhibitory Pathway mediate pain tolerance and how does it relate to chronic pain?

A

In the short term, the Descending Pathway can allow a person to withstand severe pain for a short period of time

In chronic pain, these inhibitory signals are often lost, leading to constant pain perception

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9
Q

What is plasticity?

A

Plasticity refers to the nervous system’s ability to reorganize itself and adjust it’s function/activity in response to changes in the environment

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10
Q

Is plasticity adaptive or maladaptive in chronic pain and why?

A

Plasticity is maladaptive in chronic pain because it leads to hypersenitization of the nervous system and perpetuates chronic pain

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11
Q

Does sensitization occur centrally or peripherally in the nervous system?

A

Both

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12
Q

What can cause peripheral sensitizaton?

A

Changes in signalling due to:

Distal nerve endings
Axons
Cell bodies/DRG

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13
Q

How does Peripheral sensitization lead to chronic pain?

A

Reduced threshold of nociceptors as a result of peripheral sensitization leads to chronic pain

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14
Q

Does peripheral sensitization occur acutely or chronically?

A

Either or

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15
Q

What can peripheral sensitization result in?

A

Allodynia or Hyperalgesia

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16
Q

What is Allodynia?

A

A form of peripheral sensitization where pain occurs in response to a non-painful stimuli

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17
Q

What is Hyperalgesia?

A

A form of peripheral stimulus where a mildly painful stimuli is perceived as much more painful

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18
Q

If a physical exam reveals pain to light touch, what form of sensitization has occured?

A

Allodynia, since light touch is normally not painful

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19
Q

If a physical exam reveals severe pain to pin-prick testing, what form of sensitization has occured?

A

Hyperalgesia, since pin-prick is normally only slightly painful

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20
Q

What causes sensitization at a mechanistic level?

A

Substances released by damaged tissues which augment the response of nociceptive fibers, such as Prostaglandins, leading to Hyperalgesia

21
Q

What is central sensitization?

A

A persistent state of high reactivity that lowers the threshold for what causes pain and maintains pain even after the initial injury has healed

22
Q

Does pain caused by central sensitization persist after the initial wound is healed?

A

Yes - leads to chronic pain

23
Q

What causes central sensitization at a physical level?

A

Rewiring of nerve connections centrally + loss of descending inhibition of sensory input

24
Q

Why does a loss of descending inhibitory function lead to central sensiziation?

A

Subthreshold stimuli become sufficient to generate AP’s in the Dorsal Horn neurons without inhibition, leading to sensitivity

25
Q

Does central sensitization lead to Allodynia or Hyperalgeisa?

A

Both

26
Q

How does central sensitization present?

A

Heightened sensitivities across all senses

Cognitive defects

Increased anxiety

Sick Role Behaviors

27
Q

What factors predipose central sensitization?

A

A lot of things:

Biological
Psychological
Environmental
Depression/Anxiety
Stressors
28
Q

What is the evolutionary role of pain?

A

Pain is a warning of potential or actual tissue damage and acts to protect the body

29
Q

What is the ideal pain threshold?

A

One that allows the body to prevent or minimize tissue damage without interfering with daily activities

30
Q

How can an injury and it’s associated acute pain heal?

A

Normal healing will lead to pain relief

Healing with plasticity leads to Hyperalgesia and/or Allodynia, causing chronic pain

31
Q

What is acute pain?

A

Pain from an injury or trauma that acts as a signal demanding healing

32
Q

How long does acute pain last?

A

For an expected duration of time, until the tissue has recovered from the injury

33
Q

How long does chronic pain last?

A

Longer than the time of healing for the initial injury

34
Q

How does chronic pain manifest behavioral changes in patients?

A

Guarding of the injured area, fear of movement/re-injury, generalization of pain, adoption of the sick role

35
Q

What drives chronic pain?

A

Structural changes in the nervous system = plasticity

36
Q

What symptoms does chronic pain involve?

A

Unremitting and spontaneous shooting or burning sensations as well as abnormal sensitivity to normally noxious stimuli on exam

37
Q

Why is chronic pain maladaptive?

A

Pain signals no longer serve to protect a person but become the focus of impairment and limitation for a person

38
Q

What are the two types of psychological factors in pain?

A

Affective and Cognitive factors

39
Q

What are the Affective factors in pain?

A

Depression, Anxiety, Anger

40
Q

What are the Cognitive factors in pain?

A

Catastrophizing, fear, helplessness, and decreased self-efficacy

41
Q

How does sleep play into pain?

A

Vicious cycle:

Pain leads to anxiety and impairs sleep, which decreases our ability to cope with pain

42
Q

How should acute pain be managed?

A

Rest, pharmacologic and non-pharmacologic interventions, and surgery = biomedical approach

43
Q

How should chronic pain be managed?

A

Address both physical and emotional components of a chronic disease state with an emphasis on coping and improving symptoms (may not resolve pain entirely) = biopsychosocial approach

44
Q

What is the biomedical treatment model view of pain?

A

Pain as a sensory event with an underlying disease or tissue damage involved

45
Q

What would be involved in interdisciplinary treatment of pain?

A

Psychologist, physical therapists, physicians

46
Q

What are the goals of an interdisciplinary pain program?

A

Increase physical activity, decrease pain intensity, improve psychosocial functioning

47
Q

What is pain psychology?

A

A branch of psychology that focuses on the mind-body connection, coping skills training, and mindfulness

48
Q

How does physical therapy contribute to pain management?

A

Improve range of motion, aerobic conditioning, home exercise plan, etc

49
Q

How does occupational therapy contribute to pain management?

A

Positioning/posture improvement, body mechanics, work tolerance

MSK/Derm (46 decks)

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