8 Pain and Its Assessment

Question 1

Duration of chronic pain

Answer 1

> 3 months (longer than expected healing time)

Question 2

Detect sensory input to peripheral tissues including the skin, muscles, and joints, and relay that sensory information to the central nervous system

Answer 2

Primary sensory neurons

Question 3

Neurons in the spinal cord that relay information to the thalamus and various midbrain structures

Answer 3

Second-order neurons

Question 4

Pain fibers: Thickly myelinated and fast conducting nerve fibers

Answer 4

Low-threshold Aβ fibers

Question 5

Pain fibers: Unmyelinated or thinly myelinated and slower conducting

Answer 5

High-threshold C and Aδ fibers

Question 6

Stimuli that cause (or at least have the potential to cause) tissue damage

Answer 6

Noxious stimuli

Question 7

Noxious stimuli are sensed by these pain fibers

Answer 7

High-threshold C and Aδ afferents called nociceptors

Question 8

Pain evoked by activation of high-threshold C and Aδ afferents

Answer 8

Nociceptive pain

Question 9

Nociceptive pain normally serves an important protective role by

Answer 9

Triggering withdrawal from the noxious stimulus and teaching one to avoid such stimuli in the future, thus minimizing injury in the short and long term

Question 10

Increases the excitability of nociceptors

Answer 10

Peripheral sensitization

Question 11

Consequences of peripheral sensitization

Answer 11

1) Hyperalgesia: a hyperexcitable nociceptor responds more vigorously than normal to a noxious stimulus, resulting in hyperalgesia, or exaggerated pain in response to noxious stimulation
2) Allodynia: reduction of its threshold allows a nociceptor to be activated by weaker-than-normal stimuli, resulting in allodynia, or pain in response to innocuous stimulation
3) a sufficiently large reduction in threshold will cause the nociceptor to become spontaneously active, generating action potentials in the absence of any sensory input and causing spontaneous pain

Question 12

Biochemicals that sensitize nociceptors

Answer 12

Prostaglandins
Tumor necrosis factor-alpha (TNF-α)
Interleukin 1β (IL-1β)
IL-6

Question 13

Vicious cycle of inflammation caused by release of cytokines from immune cells

Answer 13

Neurogenic inflammation

Question 14

Neurogenic inflammation can be exacerbated by the release of proinflammatory peptides like

Answer 14

Calcitonin gene-related peptide (CGRP) and P from activated nociceptors

Question 15

Causes pain signals to be amplified, but through changes occurring in the central nervous system

Answer 15

Central sensitization

Question 16

Heightened pain sensitivity that is limited to sites of inflammation resulting from sensitized peripheral neurons innervating inflamed areas

Answer 16

Primary hyperalgesia

Question 17

Peripheral vs Central sensitization: causes heightened pain sensitivity that extends beyond sites of inflammation

Answer 17

Central

Question 18

Peripheral vs Central sensitization: causes heightened pain sensitivity that affects only the neurons innervating inflamed areas

Answer 18

Peripheral sensitization causing primary hyperalgesia

Question 19

T/F Peripheral and central sensitization are not mutually exclusive

Answer 19

T, the former often contributes to the latter

Question 20

Factors associated with children and adolescents’ chronic pain (biopsychosocial model of pain)

Answer 20

Social factors
Psychological factors
Biological factors
Environmental factors

Question 21

T/F Susceptibility to such neuroplas- tic changes has a strong genetic and epigenetic component, and the latter can reflect a broad range of environmental factors such as traumatic early life experiences

Answer 21

T

Question 22

Aβ, Aδ, or C fibers: Thickly myelinated

Answer 22

Aβ

Question 23

Aβ, Aδ, or C fibers: Thinly myelinated

Answer 23

Aδ and C

Question 24

Aβ, Aδ, or C fibers: Large diameter

Answer 24

Aβ

Question 25

Aβ, Aδ, or C fibers: Medium diameter

Answer 25

Aδ

Question 26

Aβ, Aδ, or C fibers: Small diameter

Answer 26

C fibers

Question 27

Aβ, Aδ, or C fibers: Fast conducting

Answer 27

Aβ

Question 28

Aβ, Aδ, or C fibers: Medium conducting

Answer 28

Aδ

Question 29

Aβ, Aδ, or C fibers: Slow conducting

Answer 29

C fibers

Question 30

Aβ, Aδ, or C fibers: Light touch

Answer 30

Aβ

Question 31

Aβ, Aδ, or C fibers: Pain

Answer 31

Aδ, or C fibers

Question 32

Aβ, Aδ, or C fibers: Temperature

Answer 32

Aδ, or C fibers

Question 33

Aβ, Aδ, or C fibers: Itch

Answer 33

Aδ, or C fibers

Question 34

Primary afferent fibers

Answer 34

Aβ, Aδ, C fibers

Question 35

Last part of the brain where sensory input for pain is processed

Answer 35

Prefrontal cortex

Question 36

Sensory afferents and nervous system

Answer 36

Primar afferents Spinal cord Thalamus 1) Primary somatosensory cortex-Secondary somatosensory cortex 2) Secondary somatosensory cortex 3) Anterior cingulate cortex-Prefrontal cortex or Amygdala 4) Insula a) Anterior cingulate cortex-prefrontal cortex b) Amygdala

Question 37

Under normal conditions, noxious stimulus results in what pain

Answer 37

Nociceptive

Question 38

When there is peripheral sensitization, noxious or innocuous stimuli can result in

Answer 38

Primary hyperalgesia Primary allodynia Spontaneous pain

Question 39

When there is central sensitization, noxious stimuli can result in

Answer 39

Secondary hyperalgesia

Question 40

When there is central sensitization, innocuous stimuli can result in

Answer 40

Secondary allodynia

Question 41

the more immediate reaction to nociception and is more midbrain based

Answer 41

Emotion

Question 42

How cognitions amplify the experience of pain

Answer 42

attach meaning to the emotional experience and can trigger additional emotional reactions

Question 43

Cognitive coping strategies that are related to greater pain and emotional distress

Answer 43

1) Emotion-focus avoidance (catastrophizing and expressing negative emotions) 2) Cognitive self-instruction (primarily wishful thinking)

Question 44

Cognitive coping strategies that are associated with less pain

Answer 44

1) Cognitive refocusing (distraction) 2) Feelings of self-control over pain

Question 45

The first step in the effective management of pain

Answer 45

Pain assessment

Question 46

Self-reported measures of pain routinely used as a key outcome in composite measures of JIA

Answer 46

None

Question 47

When should pain be assessed among rheuma patients

Answer 47

Pain should be assessed in all patients at the first visit and at each subsequent visit

Question 48

The best predictor of whether an individual patient is able to accurately self-report pain

Answer 48

Chronological age

Question 49

Most children of this age are able to self-report their current pain when provided with a developmentally appropriate tool

Answer 49

5 to 6 years and above

Question 50

Used to assess pain for children younger than 5 years and/or patients with cognitive impairment or communication difficulties

Answer 50

An observational pain measure

Question 51

Pain scale: asks children to rate pain intensity on scale of 0 to 10

Answer 51

11-point Numerical Rating Scale (NRS-11)

Question 52

Pain scale: includes six faces from “no pain” to “very much pain”

Answer 52

Faces Pain Scale-revised (FPS-R)

Question 53

Pain scale: moves a slider along the length of the scale to indicate how much pain they have

Answer 53

Color Analog Scale (CAS)

Question 54

2 pain scale measures with low recommendation

Answer 54

VAS and NRS-11

Question 55

Pain scale measure recommended for children younger than 6

Answer 55

None

Question 56

MC used self-report pain scale intended for use in children 5-18 years and takes 10-15 min

Answer 56

Pediatric pain questionnaire (PPQ)

Question 57

A well-validated multidimensional instrument that can aid in the comprehensive assessment of chronic musculoskeletal pain in adolescents (social functioning, physical functioning, depression, general anxiety, pain-specific anxiety, family functioning, and development)

Answer 57

Bath Adolescent Pain Questionnaire (BAPQ), which has adolescent and parent versions

Question 58

A web- and mobile-based tool for the visual self-report and electronic tracking of sensory pain where patients can choose from a library of pain-quality icons to express different types of pain, can be assigned a rating of intensity (0 to 10 NRS) and then dragged- and-dropped onto a detailed virtual body map to show pain location

Answer 58

Pain-QuILT

Question 59

Observational behavioral measure intended for children 2 months to 8 years that is used routinely for acute pain

Answer 59

r-FLACC

Question 60

The r-FLACC behavioral scale uses these indicators to assess pain (FLACC)

Answer 60

1) Facial expression 2) Leg movement 3) Activity 4) Cry 5) Consolability

Question 61

Therapeutic strategy for pain that seeks to engage the child as an agent of change in his or her care and is typically delivered weekly by specially trained psychologists over the course of several months

Answer 61

cognitive-behavioral therapy (CBT)

Question 62

T/F Evidence suggests that exercise exacerbates arthritis

Answer 62

F, an updated Cochrane meta-anal- ysis of existing RCTs found that exercise does not exacerbate arthri- tis; however, this analysis also failed to identify significant evidence of improvements in pain