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MSK Exam 1 - Spring > Pain Phenotyping - Done > Flashcards

Pain Phenotyping - Done Flashcards

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1
Q

What is pain phenotyping?

A

Set of observable pain characteristics of an individual resulting from the interaction between the body and the environment

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2
Q

What is nociceptive pain?

A

Non-nervous tissue compromise

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3
Q

What two categories is nociceptive pain broken into?

A
  • MSK: including spondylogenic
  • Viscerogenic
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4
Q

What is neuropathic pain?

A

Nervous tissue compromise

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5
Q

What three categories is neuropathic pain broken into?

A
  • Radicular
  • Radiculopathy
  • Terminal Nerve Branch Neuropathy
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6
Q

What is nociplastic pain?

A

Altered pain perception without complete evidence of actual or threatened tissue compromise

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7
Q

What kind of pain produces local as well as referred symptoms from the involved spinal structure?

A

Spondylogenic

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8
Q

What is spondylogenic pain?

A
  • Pain from the spine
  • It is common
  • Local and/or referred spinal pain from noxious stimulation of spinal structures
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9
Q

Can spondylogenic pain cause visceral dysfunction?

A

CANNOT cause visceral dysfunction as some providers claim

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10
Q

Is spondylogenic pain segmental or nonsegmental?

A

Nonsegmental

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11
Q

What is a segment?

A

Two vertebrae and its spinal nerve… ex: L4-L5 and nerve between

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12
Q

How would someone describe spondylogenic pain?

A

Deep, achy, boring, and vague

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13
Q

With spondylogenic pain will you have neuro findings?

A

No, they are WNL

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14
Q

Is spondylogenic pain entirely reproducible?

A

Not entirely

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15
Q

With spondylogenic pain you have somatic convergence or referred pain. Because of this, you have sensory afferent nerves that _____ on a _____ same innervation.

A

converge, shared

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16
Q

With spondylogenic pain which do you have a greater referral of pain from? Proximal and deep structures or distal and superficial structures?

A

Proximal and deep

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17
Q

Why would you get more pain referrals from proximal and deep structures with spondylogenic pain?

A

The spinal facets are able to refer more than say a knee joint or a hip joint

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18
Q

What are symptoms of spondylogenic pain?

A
  • Non-segmental pain
  • Rarely if any paresthesias
  • Vague, deep, achy, and boring pain
  • Referred into a vague area due to somatic convergence that settles into a consistent location
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19
Q

What are signs of spondylogenic pain?

A
  • Neuro scan WNL
  • Can’t reproduce entire symptom pattern with motion
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20
Q

Where will you find spondylogenic pain in the thoracic spine?

A

Wraps around the respective vertebral levels with overlap in the trunk

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21
Q

Where will you find spondylogenic pain in the lumbar spine?

A
  • MOST often in the gluteal region and proximal thigh
  • May go as far as the foot
  • Inconsistent pattern between individuals
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22
Q

Are spondylogenic pain symptoms from a compromised spinal nerve?

A

No, and your neuro test will show you that since they are WNL

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23
Q

What is viscerogenic pain?

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A

Referred pain from an organ

24
Q

What is viscerosomatic convergence?

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A

Viscera and somatic (body) sensory afferents converge on and share the same innervation

25
How might someone describe a viscerogenic pain?
Vague, deep, achy, and boring pain
26
What is an example of referred viscerogenic pain?
Kidneys can refer into the T10-L1 dermatomes
27
What are the signs and symptoms of viscerogenic pain?
- Not typically able to be mechanically reproduced - Neuro scan WNL
28
What is radicular pain?
Ectopic or abnormal discharge from highly inflamed dorsal root of spinal nerve
29
What are symptoms of radicular pain?
Lancing, electrical shock-like pain along an extremity in a narrow 2-3" band
30
What are signs of radicular pain?
- Dermatoms, DTRs, and Myotomes likely WNL: may be difficult to localize segment if acute/mild; it takes time for hypo-activity to show - (+) Neurodynamic mobility tests due to HIGH inflammation - NOT common - Imaging helpful for involved spinal nerve
31
What is radiculopathy?
Blocked conduction of spinal nerve due to compression and/or inflammation
32
What are symptoms of a radiculopathy?
- Segmental paresthesias that are often constant and long-duration - Segmental paresthesias that have a slow progression to a vague area due to dermatomal overlap
33
What are signs of radiculopathy?
- Neuro scan (+) for spinal nerve hypoactivity - Imaging helpful for involved spinal nerve
33
What is terminal nerve branch pain?
Decreased conduction of the terminal nerve branch
34
What are symptoms of terminal nerve branch pain?
- Non-segmental paresthesias that are often intermittent and short-duration - Non-segmental paresthesias that have a fast progression to a well-defined area of numbness because of minimal sensory overlap of terminal nerve branch (unlike spinal nerve) - Possible weakness
35
What are signs of terminal nerve branch pain?
- Dermatomes, DTRs, and myotomes WNL - Non-segmental terminal nerve branch hypoactivity that leads to decreased sensation along terminal nerve branch distribution and possible weakness of muscle innervated by terminal nerve branches - (+) neurodynamic mobility tests
36
What is nociplastic pain?
- Defined as altered pain perception without complete evidence of actual or threatened tissue compromise - initial term of sensitization pain in 2010 - Current term originated in 2017 - Signs and symptoms of sensitization are present within nociplastic pain - Sensitization is an underlying mechanism - Patients with sensitization are labeled as having nociplastic pain
37
What is the pathogenesis of nociplastic pain?
- Thinning of myelin sheath - Increased sensitivity and misinterpretation by peripheral nociceptors - Persistent excitation of A-delta and C fibers
38
What sensation do A-delta and C fibers carry?
39
Persistent excitation of A-delta and C fibers inhibit what?
Inhibits larger myelinated A-beta fibers pre-synaptically making it harder to override P! with motion
40
When there is an increased sensitivity and misinterpretation by CENTRAL structures what happens?
- Increased excitability of segmental dorsal horn neurons - Lower synaptic resistance so P! sensations occur easier
41
A loss of descending anti-nociceptive mechanisms causes what?
- Less endogenous opiates released - Less P! control
42
Why can symptoms “spread” with nociplastic pain?
Somatic Convergence: Shared areas of innervation share symptoms; think of spondylogenic and referred pain
43
What is somatic convergence?
- C-fibers that transmit pain, split, and travel at least 2 spinal segments superiorly and inferiorly - Ex: persistent symptoms with L4, 5 hypermobility/instability can eventually spread and create symptoms through the entire LQ (L2- S2)... Like a domino effect
44
With somatic convergence, the brain perceives the pain as coming from where?
- Even more areas with persistent symptoms... its a downward spiral - Brain homunculus “smudged”
45
What functional questionnaires can you use for nociplastic pain?
- Central Sensitization Inventory - Neurophysiology of Pain Test: to assess fear avoidance, catastrophizing, understanding - Regional specific
46
What is the prevalence of nociplastic pain?
A growing number of conditions such as: - Migraine - Neck pain: traumatic and non-traumatic - Shoulder pain - Lateral elbow pain - LBP - Age-related Joint Changes - Persistent fatigue syndrome - Fibromyalgia
47
What is the criteria for possible nociplastic pain?
- ≥ 3 months of pain - Regional or spreading symptoms - Pain that cannot be entirely explained by nociceptive or neuropathic pathways - Pain hypersensitivity or allodynia (non-painful stimuli causing pain)
48
What is the criteria for probable nociplastic pain?
- The addition of any of the following comorbidities to “possible” criteria - Sensitivity to sound, light, and/or odor - Sleep disturbances - Fatigue - Cognitive problems
49
What kind of benefit do JM have on nociplastic pain?
- Theoretical benefits on symptoms - MOST accepted- stimulates descending inhibitory pain mechanisms i.e., MORE endorphins
50
Do JM induce or reduce presynaptic inhibition in nociplastic pain?
- Induces presynaptic inhibition - Limit pain transmission by A-delta and C fibers - Better overriding of pain by A-beta stimulation
51
What can JM reduce in nociplastic pain?
- Reduces dorsal horn excitability - Decreases inflammatory mediators
52
What should METs look like for nociplastic pain?
- Low to moderate global aerobic and resistance activities - 2-3x/wk. - 30-90 minutes per session - At least 7 weeks duration - Endogenous/opiate analgesia - Helps pt. to interpret pain and motion as non-threatening - Reorganizes Homunculus
53
Why is neuroscience education/behavioral therapy important for pts with nociplastic pain?
- Not just mind over matter - Explain increased sensitivity and misinterpretation to reduce stress/anxiety of misperceived tissue injury - Challenge the patient’s reasoning of fears - Ensure the safety of exercise - Transition to adaptive pain coping
54
What is the prognosis for someone with nociplastic pain?
- Varying degrees of improvement - Longer recovery - Likely not a full resolution of symptoms

MSK Exam 1 - Spring (9 decks)

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