Lecture 10 Flashcards
Pain Syndromes
What is a disease?
A medical condition with a specific cause or causes and recognizable signs and symptoms.
What is a syndrome?
A collection of signs, symptoms, and medical problems that tend to occur together but are unrelated to a specific, identifiable cause.
What is the most common disease?
Hypertension, followed by type 2 diabetes, ischemic heart disease, atrial fibrillation, dementia, etc.
What are the three types of clinical pain?
Acute pain (emergency room, and post-operative), cancer pain, and chronic non-cancer pain (inflammatory, neuropathic, idiopathic/functional/nociplastic, and headache)
How long do you need to have a pain problem for it to be considered chronic?
Acute pain is back pain that resolves itself within 6-7 weeks; sub acute pain is resolved within 7-12 weeks; chronic pain lasts for more than 12 weeks.
What operation has the most cases of chronic postsurgical pain (CPSP)?
Amputation (50-85%), thoracotomy (5-65%), cardiac surgery (30-55%), etc.
What are the two ways of viewing CPSP?
People who believe in acute-to-chronic pain transitioning view the concept as such: after the operation, you have pain which is supposed to be there and serves a purpose. After a specific amount of time, one or two things can happen: either the pain goes away like it’s supposed to, or the pain stays the same and becomes pathological pain; the post-operative pain and the chronic pain are the same pain.
The other way of looking at it is that there is post-operative pain after the surgery that goes away no matter what, and the chronic pain may develop due to the insult; the post-operative pain and the chronic pain are two separate pains.
According to the UK Biobank Study, what are the two statistically significant differences between the patients whose back pain got better and those whose didn’t?
1) neutrophil, which provides evidence that chronic pain is more likely to be an immune rather than a nervous system problem; and
2) people who took NSAIDs were 1.7 times more likely to have their acute back pain turn into chronic back pain
Why could NSAIDs cause acute back pain to transition to chronic back pain?
NSAIDs block inflammation from happening which blocks processes from occurring that would lead to the resolution of the back pain.
What are the two types of arthritis?
Osteoarthritis - this happens as you age; everyone gets it eventually; it can be painful or not and how painful it is cannot be predicted by looking at the joint; the cartilage between the joints gets thinner with use or age and the synovial fluid either leaks out or does not replenish itself which leads to bone-on-bone when trying to move the joints.
Rheumatoid arthritis - this is an autoimmune disease; the joint becomes inflamed and swells; it is always painful.
Who is thought of as the father of neurology?
Silas Weir Mitchell. He was a doctor during the Civil War and wrote a book called ‘Injuries of Nerves and Their Consequences’ in 1872. He discovered and termed causalgia.
What is the difference between nociceptive and neuropathic pain?
Nociceptive pain is injury to tissue, excluding nerves; the pain is generally dull and throbbing and remains in one location.
Neuropathic pain is injury to nerves or the nervous system; the pain is shooting or lancinating from place to place; it feels like an electric shock or stabbing; the pain is sharp and often described as burning; numbness and tingling/prickling (paresthesia and dysesthesia) are common in neuropathic pain; the involvement of any other neurological signs like weakness, dystonia, or spasticity point to neurological pain as they are all motor problems which signals that there is nerve involvement.
What is the most common neuropathic pain?
Painful diabetic peripheral neuropathy (PDN or DPN). The location of this is almost always the feet. The symptoms are pins and needles, burning, tingling, painful cold, and electric shock.
What is the second most common neuropathic pain?
Post-herpetic pain (PHN), which is when the pain from shingles does not resolve.
What is the percentage of people who develop post-herpetic neuralgia?
About 15% of people with shingles have their rashes resolve but not their pain.
What is usually the cause of phantom limb pain?
Amputation.
What are the most common reasons for amputation?
Type 2 diabetes, PAD (peripheral arterial disease), and trauma. Upper limb amputations are more likely to be painful and develop PLP.
What are the symptoms for phantom limb?
Cramping, shooting, stabbing, and burning. You can feel phantom itch, vibration, and temperature; you could feel your phantom limb moving without your control; you could feel referred phantom sensation (like if someone touches your face, you will feel it in your face as well as in the phantom limb); you could have phantom size, shape, and position of the limb; telescoping.
What is telescoping?
When it feels as though your phantom limb is slowly retracting into the stump; this is often associated with a clenching fist feeling.
What are some treatments for phantom limb?
Lidocaine blocks. They work best if you do a spinal block which happens in between the DRG and the spinal cord. However, the spinal block is not permanent and is invasive. Nerve blocks (which happen on the peripheral side of the DRG) are easier to do, but don’t work as well and last for even less time.
What are the two types of complex regional pain syndrome (CRPS)?
CRPS II is also called causalgia (discovered by Silas Weir Mitchell). It is mononeuropathy and follows discrete nerve distribution because only one nerve is involves or damaged; generally, we know the precipitating event to this pain. The symptoms of causalgia are burning, allodynia, hyperalgesia, shooting or lancinating pains, etc. CRPS II does not respond to sympathetic blocks, but responds well to nerve blocks.
CRPS I (also known as reflex sympathetic dystrophy or RSD) is when we don’t know the precipitating event to the pain for certain. It is the easiest pain disorder to diagnose as the limb turns red, the hair falls off, the nails get gross, and there are changes in sweating (either the limb is red and sweats all the time, or the limb is white and can’t sweat at all). CRPS I responds well to sympathetic blocks, but does not respond to nerve blocks.
What is the pain disorder with the biggest sex difference?
Fibromyalgia, with about 6-8% of middle-aged women having it and less than 1% of middle-aged men having it.
Why is fibromyalgia considered a rheumatic condition?
Because it is generally associated with pain of the joints - event though fibromyalgics feel hypersensitivity everywhere, they tend to point to their joints when asked where it hurts. The symptoms of fibromyalgia also include significant pain and fatigue, which is common in rheumatoid conditions.
Why is fibromyalgia not a form of arthritis?
There is no inflammation or nerve damage, and it affects all the joints instead of just one.
