Flashcards in Chronic pain lecture Deck (19)
What are the two different types of pain?
Neuropathic - nerve damage
Nociceptive - tissue damage
Describe somatic nociceptive pain.
Well localised - dermatomal
Sharp, aching and gnawing pain
Describe visceral nociceptive pain.
Vague distribution, diffuse
Dull, cramping and digging pain
Can be periodic
Causes nausea, vomiting, sweatiness, CV symptoms
What are the symptoms of neuropathic pain?
Electric shock like
What are some possible sources of lower back pain? (Disc, vertebrae, joints, muscle and ligaments)
Disc - bulge, rupture
Vertebrae - osteoarthritis
Joints - facet, sacro-iliac
Muscle - paravertebral, gluteal
Ligaments - anterior and posterior longitudinal
What kind of pain is lower back pain? (neuropathic, nociceptive)
Local nociceptor activation = nociceptive
Compression and inflammation of nerve root = neuropathic
What's the difference between somatic referred back pain and radicular pain in the leg?
Somatic referred pain - nociceptive pain affecting large areas of the posterior thigh
Radicular pain - neuropathic pain radiating down lower limb to the heel in a narrow band
How can pain be measured?
NRS - numerical rating scale
VAS - visual analgoue scale
Name some of co-morbidities associated with neuropathic pain.
Lack of energy
What are the 6P'S of pain treatment?
Pathology - treat it
Procesural - analgesia
Describe the WHO analgesic ladder
1 - Paracetamol, NSAIDs
2- Codeine, dihydrocodeine
3 - Morphine, methadone, oxycodone
What are the possible side effects of NSAIDs?
Decreased bone healing
Which hormone is needed to convert codeine to morphine within the body?
What criteria must be looked at before prescribing opioids?
- pain model
- pain patient
- pain prescription
From most to least effective, list conditions opioids can be used in.
Lower back pain
Name some adjuvants which can be used for neuropathic analgesics.
From least severe pain, to most severe pain, list the types of psychological treatment that can be received.
Pain management programme
Describe the lumbar facet syndrome.
Lower back pain to groin, hip or thigh
Worse on back extension/rotation
Tender over paraspinal region