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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
What are the signs of radicular pain?
* Dermatomes, DTRs, Myotomes likely WNL * Positive dural mobility tests due to high inflammation
26
Is radicular pain common?
NO
27
What is helpful for identifying the involved spinal nerve with radicular pain & radiculopathy?
imaging
28
Why are neuro tests WNL with radicular pain?
May be difficult to localize segment if acute/mild; takes time for hypeoactivity to show
29
What is radiculopathy?
Blocked conduction of spinal nerve due to compression and/or inflammation
30
What are the symptoms of radiculopathy?
* segmental paresthesias * often constant and long duration * slow progression to a vague area due to dermatomal overlap * possible weakness
31
How much conduction loss is needed before perceivable fatiguing weakness?
80%
32
What are signs of radiculopathy?
* Neuro scan positive for spinal nerve hypoactivity
33
What will be the symptoms of decreased conduction of a terminal nerve branch?
* Non-segmental paresthesias * possible weakness
34
What are the characteristics of the non-segmental paresthesias with decreased conduction of a terminal nerve branch?
* often intermittent and short duration * fast progression to well-defined area of numbness bc of minimal sensory overlap of terminal nerve branch
35
What are signs of decreased terminal nerve branch conduction?
* Dermatomes, DTRs, Myotomes WNL * Non-segmental terminal nerve branch hypoactivity * positive dural mobility (neurodynamic) tests
36
What are the characteristics of non segmental terminal nerve branch hypoactivity with decreased terminal nerve branch conduction?
* Decreased sensation along terminal nerve branch distribution * Possible weakness of muscles innervated by the terminal nerve branch
37
What is the initial term for nociplastic pain?
Sensitization pain in 2010
38
What is nociplastic pain defined as?
Altered pain perception without complete evidence of actual or threatened tissue compromise
39
What is the pathogenesis of nociplastic pain?
* Thinning of myelin sheath * increased sensitivity and misinterpretation by peripheral nociceptors * persistent excitation of a-delta and C fibers
40
What fiber type is fast first?
A- delta fibers
41
What fibers are persistent pain caused by?
Unmyelinated C fibers
42
Where do the a delta and C fibers synapse at?
The spinal cord at the dorsal horn
43
Where does nociplastic pain inhibit myelinated A-beta fibers?
Presynaptically
44
What does the inhibition of the A beta fibers do?
Makes it harder to override pain with motion
45
What happens to the central structures with nociplastic pain?
Increased sensitivity and misinterpretation, leading to increased excitability of segmental dorsal horn neurons and lower synaptic resistance so pain sensations occur easier
46
What happens with the loss of descending anti-nociceptic mechanisms?
* 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
Why can somatic convergence cause nociplastic pain to spread?
C-fibers that transmit pain split and travel at least 2 spinal segments superiorly and inferiorly
48
Where can hyper mobility/instability eventually spreadto, due to somatic convergence with nociplastic pain?
the entire LQ, like a domino effect
49
What can somatic convergence cause the brain to perceive regarding the location of the pain?
Brain perceives the pain as coming from even more areas with persistent symptoms - "downward spiral"
50
What happens to the brain homunculus with somatic convergence and nociplastic pain?
Smudged
51
Are there functional questionnaires for nociplastic pain?
Yes (be aware, don't memorize) - central sensitization inventory - neurophysiology of pain test - regional specific
52
What is the prevalence of nociplastic pain?
Growing number of conditions
53
Where can nociplastic pain present?
- migraine - neck pain (traumatic and non-traumatic) - shoulder pain - lateral elbow pain - LBP - Age-related joint changes - persistent fatigue syndrome - fibromyalgia
54
What are the criteria for possible nociplastic pain?
- ≥ 3 months of pain - regional or spreading symptoms - pain that CANNOT be entirely explained by nociceptive or neuropathic pathways - pain hypersensitivity or allodynia
55
What is allodynia?
Non painful stimuli causing pain
56
What are comorbidities that can can be criteria for probable nociplastic pain?
- sensitivity to sound, light, and/or odor - sleep disturbances - fatigue - cognitive problems
57
What is the RX for nociplastic pain?
- JM, including manipulation
58
Why is manipulation and JM effective on nociplastic pain?
- stimulates descending inhibitory pain mechanisms (i.e. more endorphins) - induced presynaptic inhibition - reduced dorsal horn excitability - decreases inflammatory mediators
59
What about the presynaptic inhibition can be induced with JM?
- limits pain transmission by A-delta and C fibers - Better overriding of pain by A-beta stimulation
60
What are the MET goals with nociplastic pain?
- 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
Is mild pain okay with nociplastic pain?
YES
62
Why does the patient need to stick with the MET prescription for at least 7 weeks?
Reorients mental perception of movement and helps with fear-avoidance
63
Where should we start with nociplastic pain MET?
2x a week at 30 minutes for 7 week before changes
64
What can we do as far as patient education for nociplastic pain?
- 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
What can explaining misinterpretation of stimuli to a nociplastic pain patient help with?
- challenges patients reasoning of fears - ensures safety of exercise
66
What is the prognosis for nociplastic pain?
Varying degrees of improvement - longer recovery - likely not full resolution of symptoms

MSK II - Exam 1 (7 decks)

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