Lecture 15: Chronic Pain

Question 1

Pain

Answer 1

An unpleasant experience associated with actual or potential tissue damage or described in terms of such damage

Question 2

Nocioceptive pain
What falls under and give example

Neuropathic pain
Give examples

Answer 2

Nociceptive is divided into
Somatic and Visceral pain

Somatic - like a fractured long bone
Visceral - cholecystitis/abd pain

Neuropathic
- failed back surgery syndrome, Diabetic Peripheral Neuropathic Pain

Question 3

Compare/contrast somatic nociceptive pain vs visceral nociceptive pain

Answer 3

Somatic
-well localized
-sharp, dull, achy
-responds well to opioids and non-opioids
-ex: broken arm, laceration

Visceral
-poorly localized or diffusely distributed
-character varies but similar to somatic pain
-responds well to opioids and non-opioids
-ex: kidney stone, appendicitis

Question 4

Facts on Neuropathic pain

What is it secondary to?
What is its character?
Does it respond to Opioids?

Answer 4

Secondary to nerve injury
Character: “burning” or “electric”
Opioid analgesics often ineffective

Question 5

Define chronic pain

Answer 5

According to FL law, chronic pain is that which has been present for more than 90 days

Question 6

Addiction Definition

Answer 6

A chronic relapsing disease characterized by compulsive drug seeking behavior and drug use despite harmful consequences and by molecular changes in the brain. This is a BRAIN DISORDER that is manifested by abnormal behavior.

Must know!
Characterized by the 4 C’s
-loss of control
-craving
-compulsive behavior
-continued use despite consequences

Question 7

If the patient has tumor, infection or scar tissue what should you be ordering?

Answer 7

A contrast enhancement MRI. This is GOLD STANDARD in spinal imaging

Question 8

What is gold standard in spinal imaging

What is second option

Other options..

Answer 8

MRI with contrast

CT
Spinal fractures and spinal stenosis

Bone scan

Question 9

Florida’s Opioid Law

“Acute pain exception” ?

PDMP ?

Answer 9

Physician can prescribe a 7-day supply if an “acute pain exception” is documented
Physician is required by law to review the patient’s PDMP profile prior to issue Ig an opioid prescription

Question 10

What does a pt with non-radicular pain respond to?

What are epidural steroids indications?

Answer 10

Epidural steroids for NON-radicular pain is often NOT effective

Herniated disc
Spinal stenosis
Post-laminectomy syndrome
Radiculopathy

Question 11

For Lumbar Facet Mediated Pain, when is a patients pain worse? Better?

Answer 11

worse with lumbar extension, lateral bending, rotation

Forward bending may not elicit any pain in lumbar facet mediated pain