Week 9 Part 1 Flashcards
What are the associations of functional somatic syndromes?
Autonomic dysregulation
Stress dysregulation
What are examples of functional gastrointestinal disorders?
IBS
What are examples of Musculoskeletal disorders?
FM
CFS
Chronic lower back pain
What is an example of Genitourinary?
Interstitial cystitis
What is an example of neurological?
Tension headache/ migraine
What is pain experienced in labour equated to?
IBS
Why is it such a burden?
Prepared to sacrifice 25% of remaining life
Pain in e.g. IBS equated to childbirth
QoL ratings worse than ESRF, DM
What is the economic burden?
Time off work: 20% greater than controls
Impaired productivity 30% of time
Healthcare costs
Who are they?
Multiple symptoms, multiple systems and Comorbid disorders
Negative effect and perceived loss of control
Anxiety and feared loss of control
Altered concentration/ memory
Often a history of abuse
Complicated by iatrogenic addiction
What is Interoception?
Capacity of being aware of what is going on inside our body
What is interception?
Sensitivity to stimuli occurring within the body
More salient and motivating
What is normal physiological processes of Interoception?
Abdominal bloating/ passage of flatus
Awareness of heart beat
What is ANS of Interoception?
Predominantly unconscious
Visceral functions
Why is it important to separate the symptoms?
Informs treatment
Informs how they have arisen
Precipitant causes of disorders developed might be different
Functional somatic syndrome
Overlap - one versus many Dysregulation of: Affect ANS Motivational salience Chronic pain
What is the definition of pain?
Unpleasant sensory or emotional experience that is associated with actual or potential tissue damage stimuli
Noxious
Damaging stimuli
What is noxious stimuli?
Something that doesn’t cause damage
What is the order of pain?
Specific injury caused pain
Tissue damage arises
Self-limiting process
Healing
What are two components of spinal component?
Painful and non-painful stimulus
Painful stimulus
High intensity
High capacity to activate receptors which have a relationship with nerve fibres
Non-painful stimulus
They do not activate the same receptors or nerve fibres or in the same cells of spinal cord
What neurosurgical does the descending inhibition require?
Dopamine
Serotonin
Noradrenaline
Opioids
What Brain regions are found in the lizard brain?
Thalamus
Basal Ganglia
What is chronic pain?
A continued state of suffering
Pain that persists past the healing phase following an injury
What is the normal healing time?
Chronic back pain = 6 months
Post herpetic neuralgia = 3 months
What are the assumptions of pain?
Pain requires damage or injury to occur
Degree of peripheral damage/injury correlate with pain
If there is a disparity - all “psychological”
What does chronic pain inform?
Diagnostic criteria
Which specialist you see
We continue to treat chronic pain as we would acute pain
What happens when we are exposed to a constant stimulus?
We may habituate
We may become sensitised
What happens when pain threshold decreases?
Allow pain to spread - secondary Hyperalgesia
What are spinal cord mechanism detectable with?
Quantitative sensory tests
What are some examples of QST?
Allodynia
Temporal summation
DNIC/CPM
What has QST been used in FSS patients to demonstrate?
Spinal sensitisation
What are examples of different substances at the level of spinal cord being examined?
Substance P Glutamate and other excitatory AAs Serotonin Nerve growth factor CCK
What are 3 subsystems the pain triumvirate divided into?
- Sensory/discriminative
- Affective/ motivational
- Cognitive/evaluative
Sensory/discriminative
Localisation in time/space - assessment of intensify
Lateral systems: lateral thalamic nuclei. S1, S2, SMA
Affective/motivational
Emotional/unpleasant aspects
Reward in escape
Medial system - BG, medial thalamic nuclei, ACC, Insula
Cognitive/evaluative
Interpretation of pain and it’s meaning
What is chronic pain?
More than acute pain
Perception
What is central augmentation?
Hyper-responsively of these brain areas
What does integrated construct allow for?
Threat assessment and memory of pain
Repetition of behaviour
In acute pain
Sensory component is dominant
Motivational component is reflexive
Affective component secondary
In chronic pain
Affective and motivational components are primary
Determine sensory component
Disruption in neurochemical circuits?
Symptoms of disorders
MDD/ anxiety
Serotonin
Noradrenaline
Dopamine
Opioid system
What is the function of serotonin?
Suppress sensation of normal bodily functions
What is the function of noradrenaline?
Suppress sensation of normal bodily functions
What is the function of dopamine?
Dampens pain
Application of importance and focuses attention
What is the function of opioid system?
Prevents spread of pain
Dampens pain
Reinforces behaviour
What are these different neurotransmitters viral for?
Interoception
What does sensation and feelings affect our beliefs about?
Meaning of symptoms
Cause of symptoms
What are 4 types of pain behaviours?
Negative affect
Facial/audible expression of distress
Distorted ambulation or posture
Avoidance of activity
What does noxious stimulus act on?
A-delta and C fibres
What is an example of sensory experience of pain?
Perception of noxious stimuli
What is example of suffering?
Negative emotional response in higher nervous system
What are examples of pain behaviour?
Expression of distress
Distortion of movement to posture
Bad mood
Avoidance of activity
What is pathway of pain behaviours
Noxious stimulus
Sensory experience of pain
Suffering
Pain behaviours
What are the altered activity?
Avoidance behaviour - most commonly
Excessive persistence
Pacing - listening to body
What is the best approach?
Behavioural intervention: graded
