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MSK II - Exam 1 > Spine- Thoracolumbar II- Pain Phenotyping > Flashcards

Spine- Thoracolumbar II- Pain Phenotyping Flashcards

1
Q

What is pain phenotyping?

A

Set of observable pain characteristics of an individual resulting from the interaction between the body and the environment

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2
Q

What is nociceptive pain?

A

Non nervous tissue compromise
- MSK ( including spondylogenic)
- Viscerogenic

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3
Q

What is neuropathic pain?

A

Nervous tissue compromised
- radicular
- radiculopathy
- terminal nerve branch neuropathy

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4
Q

What is nociplastic pain?

A

Altered pain perception without complete evidence of actual or threatened tissue compromise

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5
Q

Which of the following is common and produces local as well as referred symptoms from the involved spinal structure?

a. viscerogenic
b. spondylogenic
c. radicular
d. radiculopathy

A

b. spondylogenic

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6
Q

What is spondylogenic pain?

A

pain from the spine

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7
Q

What are some important characteristics of spondylogenic pain?

A
  • common
  • local and/or referred spinal pain from noxious stimulation of spine structures
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8
Q

What can spondylogenic pain NOT cause?

A

Visceral dysfunction

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9
Q

What are S&S of spondylogenic pain?

A
  • non segmental
  • achy and deep
  • no neuro findings
  • not entirely reproducible
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10
Q

What can cause somatic convergence or referred pain with spondylogenic pain?

A
  • sensory afferents converge on and share the same innervation
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11
Q

What structures refer more?

A

Greater referral of proximal and deep structures than distal and superficial structures

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12
Q

Which refers more - the spinal facets or the knee joint?

A

SPINAL FACETS

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13
Q

What will patients possibly describe spondylogenic pain as?

A

Vague, deep, achy and boring pain

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14
Q

What is the referred spondylogenic pain from the thoracic region like?

A

Wraps around respective vertebral levels with overlap in the trunk

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15
Q

Where does spondylogenic pain in the lumbar region refer to?

A

Most often the gluteal region and proximal thigh, although sometimes may go as far as the foot

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16
Q

Is the pattern of spondylogenic referred pain consistent between individuals?

A

NO - inconsistent pattern between individuals

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17
Q

Are the referred pain symptoms from the spondylogenic pain in the lumbar region from a compromised spinal nerve?

A

NO - do neuro tests to find out if spinal nerve

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18
Q

What is viscerogenic pain?

A

Referred pain from an organ

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19
Q

What is viscerosomatic convergence?

A

Viscera and somatic sensory afferents converge and share the same innervation

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20
Q

What is the description of viscerogenic pain?

A

Vague, deep, achy and boring pain

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21
Q

Is viscerogenic pain usually able to be mechanically reproduced?

A

NO

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22
Q

What will we find in the neuro scan with viscerogenic pain?

A

WNL

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23
Q

What is radicular pain caused by?

A

Ectopic or abnormal discharge from HIGHLY INFLAMMED dorsal root of spinal nerve

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24
Q

What are the symptoms of radicular pain??

A

Lancing, electrical, shock like pain along an extremity in a narrow 2-3” band

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25
Q

What are the signs of radicular pain?

A
  • Dermatomes, DTRs, Myotomes likely WNL
  • Positive dural mobility tests due to high inflammation
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26
Q

Is radicular pain common?

A

NO

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27
Q

What is helpful for identifying the involved spinal nerve with radicular pain & radiculopathy?

28
Q

Why are neuro tests WNL with radicular pain?

A

May be difficult to localize segment if acute/mild; takes time for hypeoactivity to show

29
Q

What is radiculopathy?

A

Blocked conduction of spinal nerve due to compression and/or inflammation

30
Q

What are the symptoms of radiculopathy?

A
  • segmental paresthesias
  • often constant and long duration
  • slow progression to a vague area due to dermatomal overlap
  • possible weakness
31
Q

How much conduction loss is needed before perceivable fatiguing weakness?

32
Q

What are signs of radiculopathy?

A
  • Neuro scan positive for spinal nerve hypoactivity
33
Q

What will be the symptoms of decreased conduction of a terminal nerve branch?

A
  • Non-segmental paresthesias
  • possible weakness
34
Q

What are the characteristics of the non-segmental paresthesias with decreased conduction of a terminal nerve branch?

A
  • often intermittent and short duration
  • fast progression to well-defined area of numbness bc of minimal sensory overlap of terminal nerve branch
35
Q

What are signs of decreased terminal nerve branch conduction?

A
  • Dermatomes, DTRs, Myotomes WNL
  • Non-segmental terminal nerve branch hypoactivity
  • positive dural mobility (neurodynamic) tests
36
Q

What are the characteristics of non segmental terminal nerve branch hypoactivity with decreased terminal nerve branch conduction?

A
  • Decreased sensation along terminal nerve branch distribution
  • Possible weakness of muscles innervated by the terminal nerve branch
37
Q

What is the initial term for nociplastic pain?

A

Sensitization pain in 2010

38
Q

What is nociplastic pain defined as?

A

Altered pain perception without complete evidence of actual or threatened tissue compromise

39
Q

What is the pathogenesis of nociplastic pain?

A
  • Thinning of myelin sheath
  • increased sensitivity and misinterpretation by peripheral nociceptors
  • persistent excitation of a-delta and C fibers
40
Q

What fiber type is fast first?

A

A- delta fibers

41
Q

What fibers are persistent pain caused by?

A

Unmyelinated C fibers

42
Q

Where do the a delta and C fibers synapse at?

A

The spinal cord at the dorsal horn

43
Q

Where does nociplastic pain inhibit myelinated A-beta fibers?

A

Presynaptically

44
Q

What does the inhibition of the A beta fibers do?

A

Makes it harder to override pain with motion

45
Q

What happens to the central structures with nociplastic pain?

A

Increased sensitivity and misinterpretation, leading to increased excitability of segmental dorsal horn neurons and lower synaptic resistance so pain sensations occur easier

46
Q

What happens with the loss of descending anti-nociceptic mechanisms?

A
  • Less endogenous opiates released, less endorphins = more pain perception and less to control it
  • less pain control (everything is emphasized from where it should be)
47
Q

Why can somatic convergence cause nociplastic pain to spread?

A

C-fibers that transmit pain split and travel at least 2 spinal segments superiorly and inferiorly

48
Q

Where can hyper mobility/instability eventually spreadto, due to somatic convergence with nociplastic pain?

A

the entire LQ, like a domino effect

49
Q

What can somatic convergence cause the brain to perceive regarding the location of the pain?

A

Brain perceives the pain as coming from even more areas with persistent symptoms
- “downward spiral”

50
Q

What happens to the brain homunculus with somatic convergence and nociplastic pain?

51
Q

Are there functional questionnaires for nociplastic pain?

A

Yes (be aware, don’t memorize)
- central sensitization inventory
- neurophysiology of pain test
- regional specific

52
Q

What is the prevalence of nociplastic pain?

A

Growing number of conditions

53
Q

Where can nociplastic pain present?

A
  • migraine
  • neck pain (traumatic and non-traumatic)
  • shoulder pain
  • lateral elbow pain
  • LBP
  • Age-related joint changes
  • persistent fatigue syndrome
  • fibromyalgia
54
Q

What are the criteria for possible nociplastic pain?

A
  • ≥ 3 months of pain
  • regional or spreading symptoms
  • pain that CANNOT be entirely explained by nociceptive or neuropathic pathways
  • pain hypersensitivity or allodynia
55
Q

What is allodynia?

A

Non painful stimuli causing pain

56
Q

What are comorbidities that can can be criteria for probable nociplastic pain?

A
  • sensitivity to sound, light, and/or odor
  • sleep disturbances
  • fatigue
  • cognitive problems
57
Q

What is the RX for nociplastic pain?

A
  • JM, including manipulation
58
Q

Why is manipulation and JM effective on nociplastic pain?

A
  • stimulates descending inhibitory pain mechanisms (i.e. more endorphins)
  • induced presynaptic inhibition
  • reduced dorsal horn excitability
  • decreases inflammatory mediators
59
Q

What about the presynaptic inhibition can be induced with JM?

A
  • limits pain transmission by A-delta and C fibers
  • Better overriding of pain by A-beta stimulation
60
Q

What are the MET goals with nociplastic pain?

A
  • Low to moderate global aerobic and resistance activities
  • 2-3x/week
  • 30-90 minutes per session
  • at least 7 weeks duration
  • endogenous / opiate analegesia
  • helps patient to interpret pain and motion as non-threatening
    -reorganized homunculus
61
Q

Is mild pain okay with nociplastic pain?

62
Q

Why does the patient need to stick with the MET prescription for at least 7 weeks?

A

Reorients mental perception of movement and helps with fear-avoidance

63
Q

Where should we start with nociplastic pain MET?

A

2x a week at 30 minutes for 7 week before changes

64
Q

What can we do as far as patient education for nociplastic pain?

A
  • Neuroscience education/ behavioral therapy
  • not just mind over matter
  • explain increased sensitivity and misinterpretation to reduce stress/anxiety of misperceived tissue injury
  • transition to adaptive pain coping
65
Q

What can explaining misinterpretation of stimuli to a nociplastic pain patient help with?

A
  • challenges patients reasoning of fears
  • ensures safety of exercise
66
Q

What is the prognosis for nociplastic pain?

A

Varying degrees of improvement
- longer recovery
- likely not full resolution of symptoms

MSK II - Exam 1 (7 decks)

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