Chronic pain Flashcards
(52 cards)
What is chronic pain
Pain >3 months persitsting beyond expected healing time for an episode of tissue damage
-> loss of function and impact on BPS model QOL
Causes of chronic pain
Nociceptice pain
Neuropathic pain
Nociplastic pain
What is nociceptive pain
Due to an organic disease
MSK eg osteoarthritis
Cancer pain, visceral pain etc
What is neuropathic pain
Pathology eg peripheral neuropathy, MS, post herpetic pain etc
What is nociplastic pain
Change/modulation - abnormal pain processing when no physical/organic damage has occurred to tissue or nerves
pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain
How is visceral pain often described
Aching, cramping, pressure
What makes somatic pain (skin, muscle, boens) distinguishable?
Aching, throbbing, sharp, stinging
Triggered by movement/plapation
Well lovalised - 1 finger point
Central pain characteristics
CNS
Constant pain
Worsened by movements
Ass w paraesthesia or hypersenstivity
What does neuropathic pain feel like
Burning, coldness, tingling, electric-shocks.
Often hard to describe
Length dependent or dermatome distribution
Where are pain signals from the ascending pathway send to in the brain
Cortex - localises
Midbrain - general arousal
Limbic system - emotional
Periaqueductal gray or PAG - feeds into inhibitory pathwya
Groups with higher incidence of chronic pain
Older age groups
Co-morbid disease: particularly depression and cardiovascular disease
Female gender
Socio-economic deprivation
Smokers
Alcohol dependence
Increased BMI
What modulates the descending pain pathwhya
PAG
What neurotransmitters foes PAG release to modulate pain response
GABA
Exogenous endorphins (which act on opioid receptors)
Serotonin
Noradrenaline
Causes of nociplastic chronic pain
Centreal sensitisation - increased responsiveness of nociceptors in CNS - non painful stimuli are painful
Reduced negative feedback - reduced inhibition in descending pathways - depression/anxiety/stress inhibit limbic and cortex
Somatisation - Psycholgical distress as physical pain or symtpoms
Yellow flags - risk factors for developing chronic pain
Maladaptive health behavious
Adtoping passive vs active coping strategies
Anxiety, depression and social isolation
Lack of social support or over protective caregivers
Ongoing litigation related to original pain or injury source
Unresolved anger
Poor job satisfaction or extended sick leave
Maladaptive health beliefs and behaviours examples that can make chronic pain worse
The belief that feeling pain means harm is occurring
Fear-avoidance of activities due to fear of pain/re-injury
Catastrophic thinking
Reliance on passive coping strategies (e.g. drugs and rest) rather than active (e.g. physiotherpay)
Low expectations of recovery
Adopting “the sick role”
Pain history questons
Current pain symptoms: SOCRATES
Impact of the pain: activities of daily living, social and psychological
Screen for red flags
Systems inquiry: associated conditions e.g. depression, IBS, connective tissue disease signs
Past medical history and other pain conditions
Drug history including opioid use and illicit drugs
Social history: support networks, job, finance
Ideas, concerns and expectations
Strategies for managing pain
Medication
Physiotherapy
Education and self care
Psychological
What need to identify in chronic pain
Features which predispose, precipitate and perpetuate chronic pain
eg pain at nihgt -> poor sleep -> un-refreshing sleep and chronic tiredness -> increased pain
Identify cycles and manage them
What is the biggest risk factor for developing chronic pain
Acutely painful experience - post op pain, acute illness or traumatic accident
Poorly controlled or ass w psychological distress
Positive diagnosis
Based on clinical findings, meet the criteria of blank
Rather than we have ruled out everything else so therefore it must be balnks = negtaive
What is chronic primary pain vs crhonic pain
Chronic = persists over 3 months
Chronic priary pain = one or more anatomical regions characterised by significant emotional distress or funcitonal disability
What conditions come under chronic primary pain
Chronic widespread ain
Complex regional pain syndrome
Chronic primary headache or orofacial pain
Chonic primary viscerla pain
Chronic primary MSK pain
Methods for assessment of pain
Visual analogue
Faces pain scale
Verbal rating eg 1-10
McGill pain questionnaire - assess initial presentation
