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Psychological Medicine Block (Unsorted) > Pain > Flashcards

Pain Flashcards

(90 cards)

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1
Q

Definition of pain

A

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

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2
Q

What is the duration of acute pain?

A

Less than 3 months

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3
Q

What is the duration of chronic pain?

A

More than/equal to 3 months

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4
Q

What are the 3 mechanisms of pain?

A

Nociceptive pain
Neuropathic pain
Nociplastic pain

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5
Q

What are the two causes of chronic pain?

A

Chronic Primary Pain

Chronic Secondary Pain

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6
Q

Describe the qualities of acute pain.

A

Pain of recent onset/probable limited duration
Useful life sustaining function
Facilitated healing through immobilization
Uncomplicated psychological processing/social appearance

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7
Q

Describe the qualities of chronic pain.

A

Pain persisting beyond healing of injury
Often no identifiable cause
Pain lasting for more than 3 months

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8
Q

What is nociceptive pain?

A

Arises from physical/potential damage to the body, reported from nociceptors to the brain by the nervous system.
Typically changes with movement, position and load

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9
Q

What are examples of nociceptive pain?

A

Bee stings, burns, tumors, inflammatory arthritis

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10
Q

Describe neuropathic pain.

A

Arises from damage to the nervous system (central or peripheral) either from disease, injury or pinching.

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11
Q

What are examples of neuropathic pain?

A 
Mechanical insults (hitting your funny bone) 
Multiple sclerosis, chemotherapy, alcoholism, phantom limb pain
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12
Q

What does neuropathic pain often feel like?

A

Stabbing, electrical, burning

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13
Q

What is nociplastic pain?

A

Arises from altered nociception
No clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors
No evidence for disease or lesion of the somatosensory nervous system causing the pain

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14
Q

What are examples of nociplastic pain?

A

Fibromyalgia (FMS), CRPS (complex regional pain syndrome)

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15
Q

Describe chronic primary pain.

A

Pain in more than/equal to one anatomical regions.
Associated with significant emotional distress/functional disability & that cannot be accounted for by another chronic pain condition.

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16
Q

List examples of chronic primary pain.

A 
Chronic widespread pain or fibromyalgia 
Complex regional pain syndrome (CRPS)
Migraines 
Temporomandibular disorders (TMD) 
Visceral (E.g. IBS) 
Musculoskeletal (non-specific LBP)
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17
Q

Describe chronic secondary pain.

A

Pain linked to other diseases as underlying cause

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18
Q

List examples of chronic secondary pain.

A

Cancer/cancer treatment
Persisting pain after normal healing time after surgery
Neuropathic pain (e.g. after stroke, diabetic neuropathy)
Orofacial/headache e.g. after injury/substances abuse
Musculoskeletal - disease process affecting bones, joints, muscles, related soft tissue (e.g. rheumatoid arthritis, osteoarthritis)

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19
Q

List the temporal patterns of chronic pain

A

Persistent
Intermittent
Persistent with overlaid attacks

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20
Q

Describe the difference between cancer and non-cancer pain.

A

Cancer pain is progressive, may be mixture of acute/chronic

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21
Q

What is nociception?

A

Neural process of encoding noxious stimuli

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22
Q

What is a noxious stimulus?

A

A stimulus that is damaging or threatens damage to normal tissues

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23
Q

What is a nociceptor?

A

High-threshold sensory receptor of the peripheral somatosensory nervous system that is capable of transducing and encoding noxious stimuli

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24
Q

Describe the organization of the sensory pathway.

A

Receptor (nociceptor): signal transduction
Primary afferent neuron: periphery to ipsilateral spinal cord
Second-order neuron:: to integrative centers in the thalamus
Third-order neuron: thalamus to higher centers

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25
What is the function of the premotor/motor cortex?
Organize/prepare movements
26
What is the function of the cingulate cortex?
Concentrating/focusing
27
What is the function of the prefrontal cortex?
Problem solving/memory
28
What is the function of the amygdala?
Fear, fear conditioning, addiction
29
What is the function of the sensory cortex?
Sensory discrimination
30
Describe the function of the hypothalamus/thalamus.
Stress response, autonomic regulation, motivation
31
What is the function of the cerebellum?
Movement and cognition
32
List the function of the hippocampus.
Memory spatial cognition, fear conditioning
33
What is the function of the spinal cord?
Gating from the periphery
34
What does the sympathetic nervous system do?
Increases HR, mobilize energy, increase vigilance, sweat
35
What is the function of the motor system?
Run away, fight, protect the damaged area
36
What does the endocrine system do?
Mobilize energy stores, reduce gut and reproductive activity
37
List the functions of the pain production system.
Motivate to escape and seek help, attract attention
38
What is the function of the immune system?
Fight invaders, sensitize neurons, produce fever, make sleepy to promote healing
39
What does the parasympathetic nervous system do?
Nourish cells, heal tissue
40
What is the mechanism of chronic pain?
Central sensitization
41
List the characteristics of central sensitization.
Repeated noxious stimulation - enhanced perception of pain (hyperalgesia) Ongoing noxious stimulation: neuroplastic changes = gene induction, synaptic strengthening
42
List the psychosocial factors that correlate in the development and maintenance of pain.
Affective factors, behavioral factors, cognitive factors (e.g. attention, beliefs, expectations, attitudes), placebo effects, social influences, psychiatric and psychosomatic comorbidity
43
Name the pyschological presentations associated with chronic pain.
Anxiety disorders, depression, sleep disorders, PTSD, abuse, unresolved or recent bereavement, problems with anger management, pain behaviours
44
What does RAT stand for?
Recognize Assess Treatment
45
What does recognizing pain involve?
Ask/observe if the patient has pain | Do other people know the patient has pain - health workers, patient's family
46
What does assessing pain incorporate?
``` What provokes/relieves the pain? Quality - describe the pain Regions - where is the pain Severity - rest vs movement Timing - constant vs intermittent ```
47
What are the questions to ask when assessing the pain? SOCRATES
``` Site Onset Characteristics Radiates Associated symptoms Timing Exacerbating/relieving factors Severity ```
48
What are the different concepts needed in a diagnosis of pain?
Acute/chronic Cancer/non-cancer Nociceptive, nociplastic, neuropathic Any other factors (physical, psychological, social)
49
What are the different methods of measuring pain?
Body charts Self report scales Self report inventories
50
List some important points to keep in mind when explaining chronic pain to patients.
Show compassion Open mind about etiology Open a dialogue about involvement of psychological factors Asses for comorbid psychological problems Realistic expectations Don't fall into a mind-body dichotomous thinking Provide a conceptual model
51
What treatment do you use for chronic non-cancer pain?
Opioids
52
What other types of drugs can you use for chronic pain?
NSAIDS
53
What does NSAIDs stand for?
Non-steroidal anti-inflammatory drugs
54
What type of pain are opioids useful for?
Neuropathic pain
55
What are the weak opioid agents?
Codeine, tramadol
56
What are the strong opioid agents?
Morphine, oxycodone, fentanyl, methadone
57
What problems are associated with opioids?
Side effects in 80% of patients - nausea, drowsiness, respiratory depression Physical dependence, tolerance, addiction
58
What are NSAIDs useful for?
Useful in short courses for pain "flare-ups" | Blocking enzyme COX (e.g. celecoxib)
59
What is the mechanism for NSAIDs?
``` Blocking enzyme COX (e.g. celecoxib) Decreases prostaglandins (inflammation, pain, fever) ```
60
What are the side effects of NSAIDs?
GI, cardiovascular, renal
61
What are antidepressants used for?
Neuropathic pain, headaches, fibromyalgia, LBP
62
What types of antidepressants exist?
``` Tricyclic antidepressants (e.g. amitriptyline) Serotonin-noradrenaline reuptake inhibitors SNRI (e.g. venlafaxine) --> less side effects ```
63
What are anticonvulsants used for?
Neuropathic pain
64
How do anticonvulsants work?
Reduce neurotransmission in abnormally active sensory neurons
65
What are examples of anticonvulsants?
Gabapentin, pregabalin
66
What are the side effects of gabapentin and pregabalin?
Sedation, dizziness
67
What are antiarrhythmics used for?
Neuropathic pain
68
What are examples of antiarrhythmics?
Lidocaine, mexiletine
69
Describe what topical analgesics are used for.
Neuropathic pain with significant peripheral component (e.g. osteoarthritis)
70
What are examples of novel and atypical agents?
Ketamine | Clonidine
71
What are cannabinoids used for?
Cancer pain, neuropathic pain
72
List the pharmalogical treatments of pain.
``` Opioids NSAIDs Antidepressants Anticonvulsants Antiarrhythmics Topical analgesics Novel and atypical agents Cannabinoids ```
73
What are further medical treatments for pain?
Interventional therapies Neuromodulation Surgical techniques
74
Describe what interventional therapies consist of.
Blocks off specific or several nerves | E.g. sympathetic nerve blocks for CRPS
75
Describe what neuromodulation entails.
Transcutaneous electrical nerve stimulation (TENS) Spinal cord stimulation Deep brain stimulation, motor cortex stimulation
76
What do surgical techniques fix?
Back pain | Correction of deformity/instability, relieves neural compressions, eradication of tumors/infections
77
List the physical therapies available for treating pain.
Physiotherapy Acupuncture Osteopathy and chiropractic
78
What does physiotherapy target?
Various types of chronic pain (especially musculoskeletal and neuropathic pain) Deconditioning, loss of confidence in movement, fear avoidance
79
What does physiotherapy consist of?
Manual therapy, electrophysical modalities, therapeutic exercise
80
What pain does acupuncture target?
Musculoskeletal pain, back/neck pain, dental/facial pain headaches
81
How does acupuncture work?
Stimulation of peripheral nervous system --> activating endogenous analgesic mechanisms
82
What pain does osteopathy and chiropractic methods target?
Musculoskeletal pain, mechanical spinal and neck pain, headaches
83
Describe how osteopathy and chiropractic methods work.
Manual techniques, high velocity thrust to a joint taking it beyond its restricted range of motion Mobilization: soft tissue release methods
84
List the psychological therapies for pain.
Cognitive behavioral techniques Acceptance/mindfulness Pain Management Programs
85
What does CBT consist of?
Education Assessing/modifying pain related beliefs Stress management Sleep strategies
86
Describe what acceptance/mindfulness is.
Acknowledging that one has pain Giving up unproductive attempts to control the pain Commit effort toward living a satisfying life despite pain Mindfulness-based strategies
87
What are Pain Management Programs?
Education Psychology input, graded exercise, communication/relationships, posture, managing everyday life, activities/work, realistic goals/pacing activities
88
List the benefits of treating pain for the individual, family and society.
Patient - physical, psychological Family - unable to function as part of family, loss of income Society - health costs, unable to contribute to community
89
Which ethnic group is less likely to report pain?
Asians and Pasifika
90
Which ethnic groups experience the most chronic pain?
Europeans and Maori

Psychological Medicine Block (Unsorted) (15 decks)

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