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MSK Final > Thoracolumbar Spine II- Pain Phenotyping > Flashcards

Thoracolumbar Spine II- Pain Phenotyping Flashcards

1
Q

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

A

Pain Phenotyping

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2
Q

Nociceptive: ___-______ compromise

A

non-tissue

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3
Q

Two types of nociceptive pain?

A

Spondylogenic
Viscerogenic

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4
Q

Neuropathic: ______ ______ compromised

A

nervous tissue

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5
Q

What are the three types of neuropathic pain?

A

Radicular

Radiculopathy

Terminal n. branch neuropathy

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6
Q

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

A

Nociplastic pain

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7
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.

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8
Q

Spondylogenic is P! from the ______

A

spine

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9
Q

Is spondylogenic P! common or uncommon?

A

common

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10
Q

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

A

Spondylogenic pain

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11
Q

True/False

Spondylogenic P! can cause visceral dysfunction

A

FALSE; it CANNOT

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12
Q

Somatic convergence= what kind of pain?

A

referred

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13
Q

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

A

converge; share

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14
Q

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

A

proximal; deep

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15
Q

The spinal facets refer _____ than the knee joint

A. LESS
B. MORE

A

B.

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16
Q

With spondylogenic P! there is _____-_____ pain

A

non-segmental

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17
Q

Non-segmental pain means what?

A

P! does not come from the spinal nerve

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18
Q

With spondylogenic P! are there any paresthesia’s?

A

rarely

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19
Q

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

A

vague, achy, deep, and boring

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20
Q

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

A

Spondylogenic P!

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21
Q

With spondylogenic pain, their neuro scan would be…?

A

WNL

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22
Q

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

A. can
B. can’t

A

B.

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23
Q

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

A

thoracic

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24
Q

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

A

gluteal region and proximal thigh

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25
Q

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

A

the foot

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26
Q

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

A

inconsistent

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27
Q

Viscerogenic pain is _______ and from an…?

(referred or local)

A

referred; organ

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28
Q

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

A

viscerosomatic convergence

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29
Q

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

A

Vague, deep, achy, and boring

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30
Q

The kidneys possibly reffering into T10-L1 dermatomes, is an example of?

A. somatic convergence
b. viscerosomatic convergence

A

B.

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31
Q

With viscerogenic pain, the neuro scan would be…?

A

WNL

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32
Q

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

A

Radicular

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33
Q

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

A

Radicular

34
Q

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

A

WNL

35
Q

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

A

bc it takes time for hypoactivity to show

36
Q

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

A

+ due to high inflammation

37
Q

Is radicular pain common or uncommon?

A

uncommon

38
Q

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

A

spinal n.

39
Q

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

A

radiculopathy

40
Q

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

A

segmental

41
Q

Segmental paresthesia’s means what?

A

pain from the spinal nerve

42
Q

With radiculopathy, it is ______ and ______ duration

A

constant; long

43
Q

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

A

dermatomal overlap

44
Q

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

A

80

45
Q

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

A

B.

46
Q

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

A

conduction

47
Q

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

A

non-segmental

48
Q

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

A

intermittent; short

49
Q

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

A

fast; minimal sensory overlap of terminal n. branch

50
Q

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

A

WNL

51
Q

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

A

hypo

52
Q

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

A

decreased

53
Q

True/False

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

A

True

54
Q

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

A

+

55
Q

Is the left nocicpetive or neuropathic symptoms?

What about the right?

A

Left- neuropathic
Right- nociceptive

56
Q

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

A

Sensitization (2010)

57
Q

With nociplastic pain, there is…..

________ of myelin sheath

Increased ______ and _________ by peripheral nociceptors (central structures)

Persistent excitation of ____-delta and ____ fibers

A

Thinning

Sensivity; Misinterpretation

A; C

58
Q

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

A

pain

59
Q

With nociplastic pain, it inhibits larger ______ A-beta fibers _________

(unmyelinated or myelinated)
(pre-synaptically or synaptically)

A

myelinated; pre-synaptically

60
Q

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

A

increased; dorsal horn

61
Q

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

A

lower

62
Q

With nociplastic P!:

There is loss of descending anti-nociceptive mechanisms

  • LESS _______ _______ ______
  • LESS ____ ______
A

endogenous opiates released

P! control

63
Q

With nociplastic pain there is what kind of convergence?

A

somatic

64
Q

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

A

C

2

superiorly

inferiorly

65
Q

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)

A

Nociplastic Pain

66
Q

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

A

MORE

67
Q

With nociplastic pain, what becomes “smudged?”

A

homunculus

68
Q

Name one nociplastic functional questionnaire

A

Neurophysiology of Pain Test

69
Q

Name some growing conditions associated with nociplastic pain

A

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

70
Q

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

A

3

regional

nociceptive; neuropathic

hypersensitivity

71
Q

_________ is non-painful stimuli causing P!

A

allodynia

72
Q

S&S or criteria for “probable” nociplastic P!

________ to sound, light, or odor

______ disturbances

Fatigue

_______ problems

A

sensitivity

sleep

cognitive

73
Q

What’s the most accepted Rx for nociplastic pain?

A

JM including manipulation

74
Q

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

A

descending; MORE endorphins

75
Q

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

A

presynaptic inhibition

76
Q

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

A

Limits

overriding

excitability

inflammatory

77
Q

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

A

Low; moderate
2-3
30-90
7

78
Q

MET for nociplastic P! patients provides:

_______/______ analgesia
Helps pt. to interpret P! and motion as ___-_______

Reorganizes _________

A

Endogenous/opiate

non-threatening

homunculus

79
Q

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

A

Analgesia

80
Q

Nociplastic Rx for neuroscience education/behavioral therapy

  • Not just ____ over ______

Explain increased ______ and _________ to reduce stress/anxiety of misperceived tissue injury

Transition to ______ ______ ______

A

mind; matter

sensitivity; misinterpretation

adaptive pain coping

81
Q

Nociplastic P! Prognosis:

_______ degrees of improvement

_______ recovery

Likely NOT _______ ______ of symptoms

A

varying

longer

full resolution

MSK Final (30 decks)

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