SM 250a - Acute vs Chronic MSK Pain

Question 1

Which of the following areas of the brain is felt to be primarily a relay station for pain messages and not an end receptor area for perception of pain and emotional suffering?

1. Prefrontal Cortex
2. Thalamus
3. Anterior Cingulate Cortex
4. Amygdala

Answer 1

b. Thalamus

Question 2

What is the cut-off between acute and chronic pain?

Answer 2

3 months

Question 3

Which section of the brain is the relay station for pain signals in the brain?

Where do signals come from?

Where do they go?

Answer 3

Thalmus

The thalmus receives signalf from the spinothalamic tract, and relays them to the somatosensory cortex and other areas of the brain

Question 4

Second order neurons ascend up the ________ to the thalmus

Answer 4

Second order neurons ascend up the spinothalamic tract to the thalmus

Question 5

What causes nociceptive pain?

Answer 5

Tissue injury and damage

Question 6

A 79 year old female with 10 year history of severe diabetic peripheral neuropathy develops severe burning pain in her distal lower extremities. On examination, light stroking of her skin, in the dorsal and plantar part of the feet, causes significant pain and guarding. This physical exam finding could be described as:

1. Paresthesia
2. Allodynia
3. Hyperalgesia
4. Hyperesthesia

Answer 6

b. Allodynia

Question 7

Which nerve fibers carry pain signals in the first order neuron after a noxious stimulus?

Where does this signal go?

Answer 7

A-delta fibers and C fibers

These primary afferent neurons carry the signal to the dorsal horn

Question 8

What is plasticity, as it refers to pain?

What is the role of plasticity in chronic pain?

Answer 8

The nervous system’s ability to reorganize itself and adjust its function and activity in response to new situations or changes in their environment.

A maladaptive response in chronic pain; contributes to a more hypersensitized nervous system, responsible for the propagation of chronic pain

Question 9

After injury, what is the result of healing with plasticity?

Answer 9

Structural chanes in the peripheral and central NS

• > Hyperalgesia and Allodynia
• > Can lead to chronic pain

Question 10

What is the goal of the interdisciplinary pain program?

Answer 10

Return the patient to the highest functional level possible with minimal pain

Teach the patient how they can manage the pain on their own

Note: goal is not to take pain away, but to minimize its impact on the patient’s life

Question 11

In normal pain processing, pain or noxious stimuli are transduced into electrical activity by various types of nociceptors. The electrical signals (action potentials) are the result of transduction and are conducted via primary afferent nociceptive neurons to the dorsal horn of the spinal cord. Signals are then transmitted to the brain via ascending pathways. The sensation of pain and the response to pain are affected not only by pain transmission but also by the brain’s response to that transmission. This can be described as:

1. perception
2. sensation
3. modulation
4. transduction

Answer 11

c. modulation

Question 12

What kinds of physical therapy are recommended for patients with chronic pain?

Answer 12

Active therapies, rather than passive

• Movement based
• Strengthening
• Range of Motion
• Aerobic conditioning
• Home exercise plan

Question 13

Which of the following statements is false?

A. Regionalization of pain is characteristic of chronic pain

B. In chronic pain anxiety can cause deconditioning

C. Depressed patients perceive less pain

D. Acute pain signals tissue injury and is protective

Answer 13

C. Depressed patients perceive less pain

Depressed patients perceive more pain; part of the physical and psychological viscious cycle of pain

Question 14

Does the biomedical treatment model work better for acute or chronic pain?

Answer 14

Acute pain

Treatment is based on the assumption that the pain is a sensory event that reflects underlying disease or tissue damage. Treat the cause of the problem, and the patient stops feeling pain

This doesn’t work as well for chronic pain

Question 15

What is sensitization to pain?

How does it contribute to our perception of pain?

Answer 15

A persistent state of high reactivity

Lowers the threshold for what causes pain

Maintains pain even after the initial injury might have healed

Can result in both allodynia and hyperalgesia

Question 16

A patient with 10 years of low back pain that now encompasses all areas of the body and presents with depression, anxiety, and fear avoidance is least likely to respond to which of the following treatments:

1. Exercise with Physical and Occupational Therapy
2. Cognitive Behavioral Therapy (CBT) with Clinical Psychology
3. Biofeedback and Other Relaxation/Mind Body techniques.
4. Lumbar fusion from L1-S1 by Spinal Surgery service

Answer 16

d. Lumbar fusion from L1-S1 by Spinal Surgery service

Question 17

All of the following are goals of the treatment of chronic pain, EXCEPT:

A. Maximization of function

B. Improve psychosocial functioning

C. Resolution of pain

D. Improve coping

Answer 17

C. Resolution of pain

Question 18

What causes neuropathic pain?

Answer 18

Injury to the nervous system

Question 19

Which of the following is not a structure of the peripheral nervous system?

A. Dorsal root ganglion

B. Mechanoreceptors

C. Dorsal horn

D. Cell body of primary afferent neuron

E. Sensory dendrites

Answer 19

C. Dorsal horn

Dorsal horn is in the spinal cord

Question 20

How does sensitization to pain occur in the central nervous system?

What is the result?

Answer 20

Central nerve connections are re-wired; may be due in part to loss of descending inhibition of pain

After sensitization, nociceptive afferent signals that were previously subthreshold become enough to generate action potentials in the secondary neurons

This results in:

• Increased pain sensitivity: both allodynia and hyperalgesia
• Heightened sensitivities of all senses
  
  • Cognitive deficits
  • Increased anxiety
  • Sick role behaviors