Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med Exam 2 > Pain Pathology > Flashcards

Pain Pathology Flashcards

1
Q

International association for the study of pain:

A

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Affects 116 million in US =

A

up to 20% of all primary care visits-chronic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

26% of adults have had pain for ___

A

> 3 months and 1/3 report it as disabling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of pain:

A

> spinal pain (LBP)
headache
arthritis
stroke
SCI
diabetes
MS
HIV/AIDS
amputation
GBS
cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

money spent on pain:

A

*Up to $635 billion/yr = economic burden

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Allodynia:

A

Pain due to a stimulus that does not normally provoke pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hyperalgesia:

A

increased pain from a stimulus that is normally painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hyperesthesia:

A

Increased sensitivity to stimulation, excluding the special senses

Hyperesthesia includes both allodynia and hyperalgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hyperpathia:

A

painful syndrome characterized by an abnormally painful reaction to a stimulus

especially a repetitive stimulus, as well as an increased threshold (augmented response to any sensory stimuli)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causalgia:

A

A syndrome of sustained burning pain, allodynia, and hyperpathia after a traumatic nerve lesion

often combined with vasomotor and sudomotor dysfunction (such as diabetic autonomic neuropathy) and later trophic changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Analgesia:

A

Absence of pain in response to stimulation that is painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dysesthesia:

A

unpleasant abnormal sensation, whether spontaneous or evoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Paresthesia:

A

abnormal sensation, whether spontaneous or evoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

classification of pain:

A

Based on:

> pain physiology
intensity
temporal characteristics
type of tissue affected
syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pain physiology =

A

nociceptive, neuropathic, inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pain Intensity =

A

mild-moderate-severe

0-10 numeric pain rating scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pain Time course =

A

acute, chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Type of tissue involved =

A

skin, muscles, viscera, joints, tendons, bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Syndromes =

A

cancer, fibromyalgia, migraine, others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Special considerations =

A

psychological state, age, gender, culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ICD Classification of chronic pain:

A

Persistent or recurrent pain lasting longer than 3 months

> primary pain
cancer pain
post-surgical/post-traumatic pain
neuropathic pain
headache/orofacial pain
visceral pain
musculoskeletal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nociceptive pain:

A

response to an immediate noxious stimulus

tissue damage with resultant inflammatory pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Neurogenic pain:

A

result of lesions in some part of the nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Central neurogenic pain:

A

injury affecting CNS

burning, aching, prickling, hyperalgesia, allodynia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Peripheral neurogenic pain:

A

injury affecting PNS

paresthesia, dysesthesia, pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Musculoskeletal pain:

A

injury affecting MSK

> Fibromyalgia
Myofascial pain syndrome
Postural stress syndrome
Movement adaptation syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Fibromyalgia =

A

widespread pain accompanied by tenderness of muscles and adjacent soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Myofascial pain syndrome =

A

persistent, deep aching pain in muscle

characterized by well defined highly sensitive tender spots ‘trigger points’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Postural stress syndrome =

A

postural malalignment produces chronic muscle lengthening and/or shortening & stress on tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Movement adaptation syndrome =

A

habituated movement dysfunction leading to muscle strain and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Psychosomatic pain:

A

origin is related to mental or emotional factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Head pain:

A

Headache, craniofacial & TMJ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Referred pain:

A

pain arising from deep visceral tissues that is felt in a body region remote from the site of origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Pain anatomy & physiology:

A

> Free Nerve Endings
Merkel’s Disc
Krause’s End Bulb
Meissner’s Corpuscle
Pacinian Corpuscle
Ruffini Corpuscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Free Nerve Endings:

A

> most abundant type of nerve endings

> lie near blood vessels between epithelial layers of the skin,

> cornea, alimentary tract, and connective tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Merkel’s Disc:

A

tactile end organ, abundant in fingertips, and whiskers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Krause’s End Bulb:

A

specialized sensory nerve ending in skin, temperature sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Meissner’s Corpuscle:

A

a cutaneous nerve ending responsible for transmitting the sensations of fine, discriminative touch and vibration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Pacinian Corpuscle:

A

encapsulated ending of a sensory nerve that acts as a receptor for pressure and vibration

40
Q

Ruffini Corpuscle:

A

found in the superficial dermis of both hairy and glaborous skin

sense low-frequency vibration or pressure

41
Q

Fast, localized pain:

A

transmitted over thinly myelinated A delta fibers

processed in dorsal horn

42
Q

Slow pain:

A

transmitted over small diameter

unmyelinated C fibers

processed in dorsal horn

43
Q

Types of nerve fibre:

A

A-alpha
A- beta
A - delta
C

44
Q

A-alpha fibre =

A

info carried = proprioception

myelinated

diameter - 13-20 micrometers

conduction speed = 80-120 m/s

45
Q

A-beta fibre =

A

info carried = touch

myelinated

diameter - 6-12 micrometers

conduction speed = 35-90 m/s

46
Q

A-delta fibre =

A

info carried = pain (mechanical and thermal)

myelinated

diameter - 1-5 micrometers

conduction speed = 5-40 m/s

47
Q

C fibre =

A

info carried = pain (mechanical, thermal, and chemical)

non- myelinated

diameter - 0.2-1.5 micrometers

conduction speed = 0.5-2 m/s

48
Q

transduction =

A

process by which a painful physical or chemical stimulus is transformed into a signal that can be carried via transmission to the central nervous system and perceived as pain

Simultaneously, the brain can alter the transmission of a pain signal via descending pain modulatory tracts

49
Q

transmission =

A

Peripheral Nervous System (PNS)

Important to isolate and D/Dx referred pain

Sharp or burning and well localized to the site of injury vs. aching, dull, and poorly localized

50
Q

Gate Control theory =

A

Spinal cord mechanism for modulating pain signal

Gate ‘open’ = pain signal let through

Gate ‘closed’ = pain signal restricted

Pain gate control mechanism located in the dorsal horn of the spinal cord

51
Q

Pain modulation =

A

Pain signal travels on C fibers

Low threshold mechanoreceptors modulate pain
> A beta fibers

52
Q

An example of the modulation of painful stimuli =

A

ability to reduce the sensation of sharp pain by activating low-threshold mechanoreceptors:

If you crack your shin or stub a toe, a natural (and effective) reaction is to vigorously rub the site of injury for a minute or two

53
Q

Melzack and Wall proposed that the flow of nociceptive information through the spinal cord is modulated by:

A

concomitant activation of the large myelinated fibers associated with low-threshold mechanoreceptors from the skin

C fibers carry pain signals to the thalamus in the brain

A- beta fibers traveling along the dorsal column- dampen or modulate a pain signal - the result begin decreased perception of pain

54
Q

Inhibitor mechanisms:

A

Descending analgesic systems: Endogenous opioids -> Endorphins & Enkephalins

Produced throughout the CNS -> can depress pain transmission at various presynaptic locations

> exrecise
acupuncture
mediation
laughter

55
Q

Referred pain:

A

pain perceived at a location other than the site of the painful stimulus/ origin

result of a network of interconnecting sensory nerves, that supplies many different tissues

When there is an injury at one site in the network it is possible that when the signal is interpreted in the brain signals are experienced in the surrounding nervous tissue

56
Q

Pain perception =

A

Two Subjective Aspects of pain: Sensory and Affective

57
Q

Sensory Aspects of Pain

A

(anterior cingulate cortex):

detection, localization, intensity, stimulus identification

58
Q

Affective Aspects of Pain

A

(prefrontal cortex & nucleus accumbens):

nagging, uncomfortable, excruciating, role of mood change

59
Q

Pain =

A

complex, multidimensional perception

varies in quality, strength, duration, location, and unpleasantness

strength and unpleasantness of pain is neither simply nor directly related to the nature and extent of tissue damage

60
Q

The experience of pain is known to have two distinct neural pathways:

A

first pathway = pain signal comes from any part of the body and activates the anterior cingulate cortex of the brain, which is associated with the perception of pain

People react differently to this stimulation because the feeling is determined by the activation of the second pathway = involving the medial prefrontal cortex and nucleus accumbens, which are associated with motivation and emotion

61
Q

there are non-physiological factors that contribute to the perception of pain, such as:

A

> personality
cognitions
beliefs
sociocultural variables
learning
emotional reactivity

62
Q

Pain comes in many forms:

A

whether it’s from a burn, joint ache, or throbbing headache

63
Q

pain tolerance =

A

refers to the maximum amount of pain you can handle

64
Q

pain threshold =

A

the minimum point at which something, such as pressure or heat, causes you pain

65
Q

Nociception:

A

neural processes of encoding and processing noxious stimuli

refers to a signal arriving at the central nervous system as a result of the stimulation of specialised sensory receptors in the peripheral nervous system called nociceptors

66
Q

nociception vs pain =

A

nociception refers to neural encoding of impending or actual tissue damage (ie, noxious stimulation)

pain refers to the subjective experience of actual or impending harm

67
Q

Central Sensitization:

A

amplification of neural signal associated with chronic pain = hypersensitivity

increased responsiveness of nociceptors in the central nervous system to either normal or sub-threshold afferent input resulting in: Hypersensitivity to stimuli

condition of the nervous system associated with the development and maintenance of chronic pain (pain itself can change how brain works, resulting in more pain with less provoking stimuli)

68
Q

Peripheral Sensitization:

A

reduced pain threshold = reduced threshold

indicates increased responsiveness due to a reduced threshold of nociceptive neurons in the periphery to the stimulation, which usually occurs after peripheral tissue injury and inflammation

69
Q

Chronic pain: risk factors

A

Injury = Re-injury, inability to remove stimuli

Disease

Genetics: Twin Studies on Central Sensitization = migraine, LBP, fibromyalgia, IBS, TMJ disorder, pelvic pain, PTSD, depression

Gender: women»men

Psychosocial History: past trauma, childhood/adult abuse, stress, low job security, low socioeconomic status, family discord, cultural beliefs, passive coping strategies

Lifestyle Factors: smoking, overweigh/obese

70
Q

Acute Pain =

A

Cause: Noxious stimulus or underlying pathology

Clinical Manifestations:
> Sharp pain
> Sympathetic changes = increased HR, BP, RR, sweating, pupillary dilation
> Anxiety

71
Q

Chronic Pain =

A

Cause: Tissue damage&raquo_space; Tissue Repair

Symptoms last > 3 months

72
Q

fibromyalgia =

A

> Common chronic condition characterized by widespread MSK pain & fatigue

> Affects ~ 5 million people in the USA

> Etiology: unknown = current theories focus on changes in the brain’s processing of painful stimuli

> Familial tendency
80-90% females

> Symptoms may begin after trauma, surgery, infection, or psychological stress

> Associated with RA, systemic lupus ankyloses spondylitis

73
Q

Pain examination

A

Examine: At rest and during movement

PQRST
SOCRATES

74
Q

PQRST =

A

> Provoking/precipitating factors
Quality of pain
Region and Radiation
Severity or associated symptoms
Temporal factors/timing

75
Q

SOCRATES =

A

> Site: Where is the pain?

> Onset: When and how did the pain start? Sudden or gradual? Trauma, illness, or other possible cause?

> Character: How does the pain feel? Sharp? Stabbing? Burning? Aching? Other?

> Radiation: Does the pain radiate? Where? What causes radiation?

> Associations: Other symptoms, such as numbness, paresthesias, heaviness, other?

> Time course: How does the pain vary over the day?

> Exacerbating/relieving: What aggravates or relieves the pain?

> Severity: Intensity rating

76
Q

Body diagrams of pain:

A

location
radiation
character

77
Q

Pain questionnaires and outcome measures =

A

> pain severity and degree of interference with function

> self-administered /interview/ phone

> short version available

78
Q

McGill Pain Questionnaire =

A

sensory, affective-emotional, evaluative, temporal aspects of pain

short form available

79
Q

Condition specific pain assessment tools

A

> Knee OA
LBP
Fibromyalgia
Headaches/Migraines
Cancer
Palliative Care
Communication Issues/Dementia

80
Q

Knee OA:

A

Western Ontario and McMaster University Osteoarthritis Index (WOMAC)

81
Q

LBP:

A

Oswestry Low Back Pain Disability Questionnaire

82
Q

Fibromyalgia:

A

Revise Fibromyalgia Impact Questionnaire (FIQR)

83
Q

Headaches/Migraines:

A

Headaches/Migraines: Headache Impact Test (HIT)

84
Q

Cancer:

A

Cancer: Brief Pain Inventory (BPI)

85
Q

Palliative Care:

A

Edmonton Symptom Assessment System, Memorial Pain Assessment Card

86
Q

Communication Issues/Dementia:

A

Communication Issues/Dementia: COMFORT Pain Scale, CRIES Pain Scale, MOBID-2 Pain Scale, FLACC Scale

87
Q

Nociceptive Pain disorder =

A

pain that arises from actual or threatened damage to non-neural tissue

88
Q

Neuropathic pain disorder:

A

pain caused by damage or alteration of the nervous system

89
Q

Medical management of chronic pain =

A

Dx: no general imaging or lab test, false positives, mismatch between imaging and physical exam

Lab tests are indicated to diagnose and treat identifiable conditions

Diagnostic nerve blocks = help determine the structure involved

Electrodiagnostic: EMG

Pharmacological: acetaminophen, NSAIDs, Ms relaxants, opioids, topical

90
Q

PT examination =

A

> Patient –centered care is key

> GUT REACTIONS

> Subjective: SOCRATES, multi-dimensional pain assessment tools, non pain S/Sx, motor/sensory/autonomic changes, psychosocial issues (abuse, anxiety, depression)

> Systems Review: CV, Pulm, MSK, Neuro, Integ Communication

> Tests and Measures = DPT Pt Management classes

91
Q

PT evaluation =

A

> Identification of factors leading to, perpetuating, or exacerbating pain

> ICF Model: personal, environmental factors affecting body structure/function, activity, and participation

> Treat or refer or consult

> D/Dx: Identify the yellow flags (psychosocial factors) and red flags (systemic involvement)

> Chronic pain poorly correlated to physical findings = identify pt specific problems (PIP) = generalized weakness, decreased ROM, poor CV fitness, decreased function

92
Q

Diagnosis =

A

Categorize the pain = acute, chronic, persistent, intermittent

Origin of pain = nociceptive, inflammatory, neurogenic (peripheral or central)

Chronic pain = sensitizations??

93
Q

Prognosis =

A

Central pain has poorer prognosis

Yellow flags associated with poor prognosis

Regular exercise, stress management, good emotional function = better prognosis

Pain readiness to change = better prognosis

94
Q

PT management of chronic pain

A

Tx Goals: deemphasize pain reduction and instead focus on restoration of activity and participation through self-management

95
Q

Multidisciplinary pain management team

A

PCP
pain specialist
physiatrist
anesthesiologist
psychiatrist
psychologist
pharmacist
social worker
case worker
DPT
OT
sleep specialist
nurse

96
Q

General principles of pain management

A

> Coping Mechanisms
Nonpharmacologic pain management techniques
Increase physical strength, endurance, and cardiovascular fitness
Increase mobility, independence, and functional activity
Improve sleep
Proper body mechanics
Increase social and recreational activities
Improve mood and cognitive function
Decrease or eliminate dependence on medications
Decrease overutilization of the health care system
Improve psychological and emotional well-being
Provide vocational rehabilitation for paid work, volunteer work, hobbies
Enhance family communication and function

97
Q

PT Intervention

A

Therapeutic exercise

Manual therapy

Neuromuscular reeducation

Assistive devices

Physical and electrotherapeutic modalities

Clin Med Exam 2 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions