Thoracolumbar Spine II- Pain Phenotyping Flashcards by Siva Pye

______ __________ is a set of observable pain characteristics of an individual resulting from the interaction between the body and the environment

Pain Phenotyping

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Nociceptive: ___-______ compromise

non-tissue

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Two types of nociceptive pain?

Spondylogenic
Viscerogenic

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Neuropathic: ______ ______ compromised

nervous tissue

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What are the three types of neuropathic pain?

Radicular

Radiculopathy

Terminal n. branch neuropathy

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_________ _____- is altered pain perception without complete evidence of actual or threatened tissue compromise

Nociplastic pain

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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

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Spondylogenic is P! from the ______

spine

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Is spondylogenic P! common or uncommon?

common

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_______ _________ is local and/or referred spinal P! from noxious stimulation of spine structures

Spondylogenic pain

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True/False

Spondylogenic P! can cause visceral dysfunction

FALSE; it CANNOT

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Somatic convergence= what kind of pain?

referred

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With somatic convergence, sensory afferents _______ and ______ the same innervation

converge; share

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With somatic convergence, there is a greater referral of ______ and ______ structures

proximal; deep

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The spinal facets refer _____ than the knee joint

A. LESS
B. MORE

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With spondylogenic P! there is _____-_____ pain

non-segmental

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Non-segmental pain means what?

P! does not come from the spinal nerve

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With spondylogenic P! are there any paresthesia’s?

rarely

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How would your pt. with spondylogenic P! describe their P! to you?

vague, achy, deep, and boring

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___________ _______ is referred into a vague area due to somatic convergence that settles into a consistent location

Spondylogenic P!

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With spondylogenic pain, their neuro scan would be…?

WNL

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With spondylogenic pain, you ____ reproduce the entire symptom pattern with motion

A. can
B. can’t

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With spondylogenic P! in the ______ area it wraps around respective vertebral levels with overlap in trunk

thoracic

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With spondylogenic pain in the lumbar spine, it is MOST often in what region/area of the body?

gluteal region and proximal thigh

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With spondylogenic pain in the lumbar spine, it may go as far as...?

the foot

With spondylogenic pain in the lumbar spine, it is an ________ pattern between individuals

inconsistent

Viscerogenic pain is _______ and from an...? (referred or local)

referred; organ

_________ ________ is when the viscera and somatic (body) sensory afferents CONVERGE on and SHARE the same innervation

viscerosomatic convergence

How would your pt. with viscerogenic P! describe their P! to you?

Vague, deep, achy, and boring

The kidneys possibly reffering into T10-L1 dermatomes, is an example of? A. somatic convergence b. viscerosomatic convergence

With viscerogenic pain, the neuro scan would be...?

WNL

_______ P! is an ectopic or abnormal discharge from HIGHLY INFLAMMED dorsal root of spinal n.

Radicular

Which neurological p! has symptoms that are lancing, electrical shock like P! along an extremity in a narrow 2-3” band?

Radicular

With radicular P! Dermatomes, Myotomes, and DTRs would be...?

WNL

With radicular pain, it may be difficult to localize segment if acute/mild...why?

bc it takes time for hypoactivity to show

With radicular pain, neurodynamic mobility test would be....and why?

+ due to high inflammation

Is radicular pain common or uncommon?

uncommon

With radicular pain, imaging can be helpful for the involved ______ ______

spinal n.

___________ is the blocked conduction of spinal nerve (n.) due to compression and/or inflammation

radiculopathy

With radiculopathy, the patient will experience what kind of paresthesia's?

segmental

Segmental paresthesia's means what?

pain from the spinal nerve

With radiculopathy, it is ______ and ______ duration

constant; long

With radiculopathy, there is slow progression to a vague area due to....?

dermatomal overlap

With radiculopathy, there could be possible weakness- ___% of conduction loss is needed before perceivable fatiguing weakness

With radiculopathy, the neuro scan would be + for ? A. hyperactivity B. hypoactivity

With pain phenotyping, terminal n. branches have decreased....?

conduction

With pain phenotyping, terminal n. branches have what kind of paresthesia's?

non-segmental

With pain phenotyping, terminal n. branches paresthesia's are often _______ and ______ duration

intermittent; short

With pain phenotyping, terminal n. branches have a _______ progression to a well-defined area of numbness bc of what?

fast; minimal sensory overlap of terminal n. branch

With pain phenotyping, terminal n. branches' dermatomes, myotomes, and DTRs would be?

WNL

With pain phenotyping, terminal n. branches will have non-segmental _____activity

hypo

With pain phenotyping, terminal n. branches, there will be _______ sensation along the terminal n, branch distribution.

decreased

True/False With pain phenotyping, terminal n. branches will have possible weakness

True

With pain phenotyping, terminal n. branches, neurodynamic mobility tests would be....?

Is the left nocicpetive or neuropathic symptoms? What about the right?

Left- neuropathic Right- nociceptive

What was the initial term for nociplastic (2017) pain?

Sensitization (2010)

With nociplastic pain, there is..... ________ of myelin sheath Increased ______ and _________ by peripheral nociceptors (central structures) Persistent excitation of ____-delta and ____ fibers

Thinning Sensivity; Misinterpretation A; C

A-delta and C fibers carry what kind of sensation?

pain

With nociplastic pain, it inhibits larger ______ A-beta fibers _________ (unmyelinated or myelinated) (pre-synaptically or synaptically)

myelinated; pre-synaptically

With nociplasitic pain, there is _______ excitability of the segmental _____ _____ neurons

increased; dorsal horn

With nociplastic, there is ______ synaptic resistance so P! sensations occur easier

lower

With nociplastic P!: There is loss of descending anti-nociceptive mechanisms - LESS _______ _______ ______ - LESS ____ ______

endogenous opiates released P! control

With nociplastic pain there is what kind of convergence?

somatic

With nociplastic pain, there are __ -fibers that transmit P!, split and travel at LEAST __ spinal segments ______ and ______

C 2 superiorly inferiorly

Which pain phenotype is this an example of? Persistent symptoms with L4, 5 hypermobility/instability can eventually spread and create symptoms through the entire LQ (L2-S2)

Nociplastic Pain

With nociplastic pain, the brain perceives the pain as coming from even ________ areas with persistent symptoms

With nociplastic pain, what becomes "smudged?"

homunculus

Name one nociplastic functional questionnaire

Neurophysiology of Pain Test

Name some growing conditions associated with nociplastic pain

Migraine Neck pain- traumatic and non-traumatic Shoulder pain Lateral elbow pain LBP Age-related Joint Changes Persistent fatigue syndrome Fibromyalgia

S&S or criteria for “possible” nociplastic P! ≥ __ months of P! ______ or spreading symptoms P! that CANNOT be entirely explained by ________ or ________ pathways P! _________ or allodynia

3 regional nociceptive; neuropathic hypersensitivity

_________ is non-painful stimuli causing P!

allodynia

S&S or criteria for “probable” nociplastic P! ________ to sound, light, or odor ______ disturbances Fatigue _______ problems

sensitivity sleep cognitive

What's the most accepted Rx for nociplastic pain?

JM including manipulation

For a patient with nociplastic pain, JM stimulates ____________ inhibitory P! mechanisms, also known as _______ _________

descending; MORE endorphins

When a patient with nociplastic P! undergoes JM, it will induce _______ ________

presynaptic inhibition

JM for patients with nociplastic pain help with : ________ P! transmissions by A-delta and C fibers Better _______ of P! by A-beta stimulation Reduces dorsal horn ________ Decreases ________ mediators

Limits overriding excitability inflammatory

What is the appropriate MET Rx for patients with nociplastic pain? ____to _______ global aerobic and resistance activities ___-_____x/wk ____-_____ minutes per session AT least __ weeks duration

Low; moderate 2-3 30-90 7

MET for nociplastic P! patients provides: _______/______ analgesia Helps pt. to interpret P! and motion as ___-_______ Reorganizes _________

Endogenous/opiate non-threatening homunculus

__________ is a loss of sensation of pain that results from an interruption in the nervous system pathway between sense organ and brain

Analgesia

Nociplastic Rx for neuroscience education/behavioral therapy - Not just ____ over ______ Explain increased ______ and _________ to reduce stress/anxiety of misperceived tissue injury Transition to ______ ______ ______

mind; matter sensitivity; misinterpretation adaptive pain coping

Nociplastic P! Prognosis: _______ degrees of improvement _______ recovery Likely NOT _______ ______ of symptoms

varying longer full resolution