Unit 5: Pain Phenotyping

Question 1

Difference between radiculopathy and radicular?

Answer 1

Radiculopathies come with neurological deficits. Associated with axonal damage causing reflex, sensory, motor deficits.

Question 2

Are all radiculopathies radicular?

Answer 2

All radiculopathies are radicular, but not all radicular pains are radiculopathy.

Question 3

Top down - centrally dominated pain

Answer 3

Nociplastic pain.

Pain arising from altered nociception despite no evidence of actual or threatened tissue damage.

Question 4

SPACE

Nociplastic associated symptoms

Answer 4

Sleep disturbance
Widespread diffuse pain
Affective perturbation
Cognitive disturbance
Energy deficit

Question 5

Nociceptive Inflammatory Clinical Indicators

Answer 5

Usually constant P (with P at rest)
P with movements/loading that are not typically painful

ALL movements are aggravating, NO ability to modify symptoms

identifiable mechanism of re-aggravation 0-3 weeks prior to presentation

well localized (unless around a nerve)

More pain with movements/loading that are typically painful

RESPONDS to NSAIDs/ice

Question 6

Neuropathic Dominant Clinical Pain Features

Answer 6

Burning, shooting, prickling quality

dominant pain is DISTAL

Numbness

Neuroanatomically plausible (dermatomal or peripheral nerve distribution, glove&stocking)

Pins&Needles/tingling (paresthesia)

Deep buttock pain (L5 nerve root)

Question 7

Objective Peripheral Neuropathic Pain Features

Answer 7

Symptom provocation with tests that move/load or compress neural tissue:

SLR
Arm squeeze
Braggard's
Upper Limb Tension Tests
Spurling's Test
Slump Test
MOTOR weakness
Atrophy
Asymmetrical Reflexes
Trendelenburg Sign

Question 8

Nociplastic Dominant Pain Clinical Features

Answer 8

Pain greater than 3 months

Diffuse

Disproportionate, non-mechanical, unpredictable pattern of provocation

unresponsive to frontline
conserv & pharm tx

Psychosocial contributors

HYPERsensitivity of senses

Functional impairments

NOTHING relieves, everything aggravates

high use of healthcare services

SPACE
Sleep disturb, diffuse P, Affective perturbation, Cognitive disturbance, Energy deficit

COPC

Question 9

COPC

Answer 9

Chronic
Overlapping
Pain
Conditions

• fibro, chronic fatigue, migraines, restless leg, IBS, tension headache, endometriosis

Question 10

Nociceptive Mechanical Clinical Indicators

Answer 10

Clear mechanical nature to aggravated/relieving factors

dull, aching quality

well localized

usually intermittent/sharp with movement/provocation (can be constant)