Diagnosis of pain Flashcards
(24 cards)
Describe somatic pain and its characteristics
Somatic pain is localized in the skin, soft tissue, muscles, and bones, caused by the activation of pain receptors in these (musculoskeletal) areas. Characteristics include:
Achy
Throbbing
Dull
Localized
Describe visceral pain and its characteristics
Visceral pain originates from internal organs (e.g., lungs, liver, stomach) and results from inflammation, distension, or stretching of the internal organs (e.g. cancer related pain in chest abdomen or pelvis). Characteristics include:
Squeezing, pressure - Deep
Cramping - Vague in location
Dull
Describe neuropathic pain and its characteristics
Neuropathic pain arises from damage to the peripheral or central nervous system. May be mistaken as somatic pain and so wrong medication may be prescribed. Characteristics include:
Burning
Shooting
Tingling
Numbness
Radiating
What are the categories of pain
Acute and chronic
What are the characteristics of acute pain
Acute pain is a brief sensation lasting less than three months, typically starting suddenly due to injury or illness (e.g., sprained ankle, appendicitis). It serves as a danger warning and is an opportunity for subsequent learning.
What are the characteristics of chronic pain
Chronic pain persists for more than three months, often impairing other functions. Primary chronic lacks objective medical findings. Examples include joint pain from rheumatoid arthritis, fibromyalgia, cancer.
What are the effects of chronic pain on patients
Medication abuse
Difficulty sleeping
Depression (e.g., lethargy, sleep disturbance, weight loss)
Somatic preoccupation
Lifestyle changes (e.g., quitting work)
Change in self-image (e.g., disability)
Increased risk of suicide
What are the categories of chronic pain
Chronic Recurrent Pain: Benign condition causing intense pain alternating with pain-free periods (e.g., migraines, tension headaches, endometriosis).
Chronic Intractable-Benign Pain: Benign condition causing persistent pain with no pain-free periods (e.g., low back pain).
Chronic Progressive Pain: Malignant condition that causes continuous pain that increases with disease progression (e.g., cancer, rheumatoid arthritis).
What are the differences between chronic primary and chronic secondary pain
Chronic primary pain lacks a clear underlying condition that accounts for the level of pain an individual is feeling. The pain is out of proportion to the observable injury or disease (e.g. musculoskeletal pain with fibromyalgia), while chronic secondary pain is a symptom of an underlying medical condition (e.g. pain associated with cancer).
What is congenital analgesia
This rare genetic disorder results in the inability to perceive physical pain. A notable case is Miss C, who suffered severe injuries without pain perception and died at age 29 due to her condition.
What is episodic analgesia and what are its characteristics
This condition involves experiencing little pain despite serious injuries. 6 Key characteristics include:
Condition has no relationship to the severity or the location of the injury
No simple relationship circumstances - occurs in battle or at home
Victim fully aware but feels no pain
Analgesia is instantaneous
Analgesia lasts for a limited time
Analgesia is localised pain can be felt in other parts of the body
What are the parts of the McGill pain assessment
Part 1: Pain localization - localise the pain and identify wether the pain is superficial (external), internal or both
Part 2: Pain rating index (76 words in 20 categories)
Groups 1-10 = description
Groups 11-15 = affective
Group 16 = evaluative
Group 17-20 = miscellaneous words
Part 3: Patterns and triggers
Part 4: Intensity of pain
What happens during diagnosis of pain
Diagnosis often occurs at the primary care level, with referrals to secondary care depending on the medical condition or if the patient doesn’t respond to the treatment options at primary care level. For complex cases patients can be referred to specialist pain clinics. Pharmacists play a crucial role in pain management.
What are the 3 different kinds of headache
Sinus headache - pain behind browbone or cheekbone
Tension headache - pain like a band squeezing the head
Migraine - pain nausea and visual changes
What is the diagnostic criteria for a tension headache
Lasting 30 minutes to 7 days, with at least three of the following:
Bilateral location
Pressing/tightening quality (non pulsating)
Mild or moderate intensity
Not aggravated by physical activity
No nausea, vomiting, photophobia (intolerance to light), or phonophobia (intolerance to loud sound)
Not attributable to another disorder.
What are the causes and risk factors of a tension headache
Causes are uncertain but may relate to muscle contractions in head and neck, genetic factors, and various triggers (e.g., eye strain, fatigue, stress, infection, poor posture, dehydration, missing a meal). Prevalence peaks at ages 40-49, with a higher occurrence in women.
What are the diagnostic criteria for a migraine
Migraine lasts 4 to 72 hours and is characterized by at least 2 of the following:
Unilateral location
Pulsating quality
Moderate to severe intensity
Aggravation by routine physical activity
At least 1 of the following:
Nausea
photophobia/phonophobia/osmophobia (smells)
and
At least 5 attacks fulfilling these criteria
No evidence of organic disease
What is positive and negative migraine aura and what are their symptoms
Positive and negative neurological symptoms can occur in addition to the migraine (this is aura), including visual disturbances and reversible brain symptoms.
Poisitve - visual flashes , spots, zigzag lines - tingling sensations - resolves in 1 hour
Negative - visual blind spots - numbness - speech or word finding problems - trouble thinking - resolves in an hours.
What are the common triggers of a migraine
Foods (e.g., spices, wine, chocolate)
Food additives : MSG
Sleep patterns - too much, too little
Stress
Female hormones : fluctuating or falling
What are the characteristics of a typical migraine patient
Typical migraine patient - onset is often as a child/teenager/young adult but can happen at any age. 2-3 x more common in women than men. Typical patient is a young woman - 15 % of all women.
What is sinusitis? It’s signs and symptoms
Inflammation of the sinuses (hollow air filled cavities that produces mucus) caused by viral bacterial or fungal infection, leading to symptoms like pain, pressure, and nasal congestion as well as swelling around the cheeks, eyes or forehead. This pain worsens when bending forward or lying down.Can also cause a blocked nose, reduced sense of smell, bad breath, achy feeling in the upper teeth, green or yellow mucus
What are the signs and symptoms of a cluster headache
Characterized by excruciating, penetrating, continuous, non throbbing pain, lasting 15 minutes to 3 hours, occurring at the same time each day, always on the same side, often in clusters (4 to 12 weeks once a year usually in spring or autumn). Causes watering eyes, nasal stiffness, runny nose, red eyes, swollen eyelids, sweating, tearing. Typically seen amongst male middle aged smokers
What are other causes of headaches
Includes primary angle-closure glaucoma (increase of pressure in the eyes, rare in middle age, can cause dramatic or mild headache and eye pain)
medication overuse (people who use analgesics 2-3 times a week), associated with caffeine, paracetamol, codeine and triptans
Hypertension. Only in acute cases
What serious causes of headaches require immediate referral
Intracranial tumors - always causes epilepsy, unsteady gait, hypertonia, anosmia, amnesia, tinnitus, visual disturbances - tends to cause headaches when quite large
Meningitis - infection and inflammation of lining of brain or spinal cord- accompanied by fever, neck stiffness and non blanching rash.
Subarachnoid hemorrhage - brain bleed, sudden onset of explosive headache, neck stiffness - may take hours to develop, nausea vomiting, reduced consciousness
Temporal arteritis - arteries around head become inflamed. Suspect this if patients over 50 present with new headache. Unilateral pain with fever and myalgia (muscle pain), the headache is accompanied by marked scalp tenderness, headache is persistent but worse at night, Jaw claudication is suggestive of TA
