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PSYC 302 Post midterm 2 > Pain Syndromes > Flashcards

Pain Syndromes Flashcards

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1
Q

What is the difference between diseases and syndromes?

A

-Diseases when we know the cause
-Syndrome when we don’t know the cause -> defined by its signs ant symptoms

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2
Q

What is the top 3 most prevalent disease?

A
  • hypertension
  • type 2 diabetes
  • ischemic heart disease
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3
Q

What are the 3 types of clinical pain?

A
  • Acute pain
  • Cancer pain
  • Chronic non-cancer pain
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4
Q

When someone presents themselves at the ER, who had priority?

A
  1. Not breathing
  2. Bleeding out
    Bottom –> pain
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5
Q

Is back pain always chronic?

A

No

Acute –> 6-7 weeks
Sub acute –> 7weeks - 3 months
Chronic –> 3 months

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6
Q

Who is Scott Reuben?

A

Fabricated evidence for the efficacy of preemptive analgesia –> no actual evidence that it works

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7
Q

Does analgesia before surgery work?

A

Seems reasonable and makes sense but there is no evidence for it

If it stops nociceptive input during the surgery, it seems like it should work, but it doesn’t

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8
Q

If some was given presurgical and post surgical analgesia, would they feel pain?

A

-They would only feel the inflammatory pain after the analgesia wears off

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9
Q

What are your odds of developing chronic post-surgical pain?

A
  • It depends on which type of surgery you have
  • Amputations are the highest % of CPSP
  • Even if the incidence of CPSP are low, since so many people get surgeries every year, that is still LOTS of people
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10
Q

Do surgical consent forms list the risk of developing CPSP?

A
  • No because the surgeons are the ones making the consent forms

Cosmetic surgery risk - 15-50% risk

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11
Q

What are the two theories as to how Acute pain turns into chronic pain

A

Transitioning
- Have acute physiological pain which either 1. resolves or 2. turns into chronic pathological pain

Non-transitioning
- Have acute postoperative pain that resolves in everyone BUT some people go on to develop chronic pain which is its own separate thing

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12
Q

How does blocking inflammation affect the acute-to-chronic pain transitioning?

A
  • 500 000 participants
  • 130 000 had back pain at t0
  • 40 000 had acute back pain at t0
  • at t1 2 000 had chronic back pain

What is the difference between the 2 000 people who went on to develop chronic back pain vs the 38 000 who got better?

They took NSAIDs (or steroids) which made them 1.67 times more likely to develop chronic back pain.

TAKEAWAY: Blocking inflammation is effective for acute pain BUT seems to block processes that are crucial during the healing process

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13
Q

Is cancer pain constant?

A

NO, it spikes throughout the day

  • Need around the clock medication for background pain
  • Stronger opioids for breakthrough pain
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14
Q

Which types of cancer are more likely to be painful?

A
  • Ones that metastasize intro your bones
    -i.e. leukemia is not likely to be painful but bone cancer almost always is.
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15
Q

Why can’t we give chemo drugs at such high doses?

A
  • Chemo drugs are effective if given at extremely high doses
  • The problem is that when given at these high doses, they cause peripheral neuropathy (nerve damage) that causes tingling, numbness and pain
  • 20-30% of peripheral neuropathy is painful
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16
Q

What is the difference between osteoarthritis and rheumatoid arthritis?

A

Osteoarthritis
- Thinned cartilage, fluid leaking or not replenished
- Eventually the bones rub together
- More common in old age
- Not sure where the pain comes from because no correlation between joint damage and pain levels

Rheumatoid arthritis
- Always painful
- More common in youth
- Autoimmune disease where your synovial membrane/ joint gets inflamed

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17
Q

What are treatment for rheumatoid arthritis?

A
  • Tylenol
  • NSAIDs
  • Glucocorticoids (steroids)
  • DMARDS a.k.a. disease modifying antiarthritic drugs –> aimed to treat joint degeneration –> to treat disease process
  • MABS –> block the growth factor TNF alpha which will reduce inflammation –> to treat the symptoms
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18
Q

What is Silas Weir Mitchell’s contribution to pain?

A
  • Coined Causalgia –> neuropathic pain
  • AKA the father of neurology
  • Invented rest cure (women should stay if bed if experiencing causalgia)
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19
Q

What causes neuropathic pain?

A

nerve dysfunction always causes neuropathy –> SOMETIMES painful

  • Nerve trauma (stump pain)
  • Iatrogenic nerve injury (doctor inflicted)
  • Nerve compression (carpal tunnel, by tumors)
  • Inflammation (damage to surrounding nerves
  • Metabolic
  • Toxins
  • Radiation
  • Hereditary
  • Autoimmune (Guillain barre)
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20
Q

What is the difference between neuropathic and nociceptive pain?

A

Nociceptive
- Caused by tissue damage (or potential damage)
- Descriptors: dull, throbbing
- Sensory deficits uncommon
- No real motor deficits just weakness
- Primary hyperalgesia to the immediate area
-no distal radiation

Neuropathic
- Caused by nerve damage
- Descriptors: shooting, electric, sharp, burning
- Sensory deficits: paresthesia, dysthesia
- Motor deficits: dystonic, spasticity
- Secondary hyperalgesia and referred pain
- Pain shoots out towards extremities

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21
Q

What is the #1 most common neuropathic pain?

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A

Diabetic peripheral neuropathy (PDN)

22
Q

Where does painful diabetic peripheral neuropathy begin, and why?

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A
  • Location begins in the feet because those neurons are the longest and are therefore the weakest
23
Q

What causes painful diabetic peripheral neuropathy?

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A

Metabolic dysfunction caused by diabetes that damages nerves

24
Q

What does polyneuropathy mean? Is PDN a polyneuropathic disease?

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A

Neuropathic disease that affects MANY nerves.

PDN is polyneuropathic it just does not affect all nerves equally –> the longest and weakest are most at risk

25
What is shingles? What is post-herpetic neuralgia?
-Shingles is a chicken pox virus that lays dormant in one of your DRG neurons. With age, your immune system weakens and the virus has a greater change of getting reactivated - 15% of those with shingles will develop Post-herpetic neuralgia, which is pain from the rash --> pain continues even after the rash is gone
26
What are the treatments for shingles?
Shingrix and Zostavax are vaccines to prevent shingles AND dementia
27
What is the number 1 reason why people get their limbs amputated?
Type 2 diabetes
28
What is the chance of developing neuropathy after getting a limb amputated?
100% Nerve damage = neuropathy!
29
What affects your chances of developing phantom limb pain?
Upper limb amputations cause more severe and more frequent PLP
30
What are the symptoms of phantom limb pain?
- pain - itching, vibrating, temperature - movement, cramping, shooting, stabbing, burning - telescoping --> feel as if the phantom limb is retreating into the stump - referred phantom sensation --> i.e. feel touched on their phantom limb if you touch their face - still feel theirs rings on the amputated limb
31
What are the 2 theories behind what causes phantom limb pain?
Unsure whether its caused by central changes (in the brain or spinal cord) OR if its caused by peripheral changes (stump, ectopic firing)
32
What happens to your sensory cortex when you develop phantom limb pain
Cortical reorganization in the somatosensory and motor cortex that used to encode your phantom limb are taken over by adjacent body part regions
33
What are the treatments for phantom limb pain?
Treatments are NOT promising -NSAIDS, opioids, etc. are less than 30% effective - Lidocaine nerve blocks eliminate pain in 50% of patients but this only offers TEMPORARY relief --> cannot go to hospital every day --> spinal blocks are more effective than peripheral ones but they are harder to administer - Mirror box (to trick our brain to think that our limb is still there) --> evidence didn't hold up but the trial showed that mirror therapy reduced pain
34
What is the difference between complex regional pain syndrome Type 1 and Type 2?
CRPS 1 (NO CLUE WHAT IS THE CAUSE) - Not always clear what the precipitating event was - Not clear how many nerves involved - Generally the limb looks fine - Swelling - Responds well to peripheral blocks CRPS 2 (NERVE DAMAGE) - Causalgia (single event caused it) - 1 nerve affected (mononeuropathy) - Typical of our animal models - Redness - Response well to nerve blocks Both: Hair loss, sweating, nail changes
35
What is Fibromyalgia?
- Nociplastic pain - WAY more common in women - Rheumatic condition that causes chronic pain in the joints - NOT ARTHRITIS --> No inflammation or damage to joints and surrounding tissue just pain there
36
Are fibromyalgia tender points legit?
Not really - They are hypersensitive everywhere but it used to ben believed that some areas were more allodynic than others
37
What evidence is there to prove that fibromyalgia is real?
The FMRI scans of patients with fibromyalgia receiving normal stimuli have brain activation that looks similar to healthy controls receiving painful stimuli
38
What is a good predictor of who will develop a pain syndrome?
High catastrophizing scores
39
How does windup relate to patients with fibromyalgia?
Fibromyalgia patients have INCREASED WINDUP --> have way more ascending pain information than healthy controls (25 more points) Hypothesis --> their pain is amplified
40
How does pain modulation relate to fibromyalgia?
Fibromyalgic patients are thought no be unable to inhibit pain input through their descending modulatory pathways --> No evidence of conditioned pain modulation Hypothesis --> their pain is due to a lack of inhibition
41
How does small-fiber neuropathy relate to fibromyalgia?
Hypothesis --> fibromyalgia is a neuropathic disorder caused by too little innervation of nociceptors (NOT NOCIPLASTIC) -Evidence that half of FM patients have peripheral nerve damage in the small nerve endings of their primary afferents
42
What are the common overlapping symptoms of idiopathic pain conditions?
- Fatigue - Pain - Cognitive problems - Mood dysregulation
43
What is surprising about the pain location of painful idiopathic syndromes? How does this affect diagnosing?
Hypersensitivity to pain is sometimes not specific to a specific body part (like we once thought) -i.e. IBS are hypersensitive in their fingernails and shoulders - i.e. Vestibulodynia patients are ONLY hypersensitive to their vulvar vestibule --> they are also sensitive in body areas far away from where they are complaining These conditions aren't as different as we once thought --> they tend to be hypersensitive everywhere Looking for a pathology in a specific body part will probably yield the wrong results --> a diagnosis is going to be biased based on which specialist you go to and which hypersensitive area he chooses to focus on.
44
What are the 4 types of headaches?
- Sinus - Cluster (around 1 eye) - Tension (forehead) --> most common - Migraine (one side of the head) --> more common in women
45
What are the differences between tension and migraines?
- Migraines are photo and phono phobic --> hypersensitive to light and sound - Migraines pulse where tensions feels like tightening - Migraines are unilateral, tensions are bilateral
46
What are the 4 stages of a migraine?
1: Prodrome (symptoms signaling onset) --> light/sound sensitivity, irritability, depression 2. Aura --> changes in visual perception 3. Headache --> up to 3 days 4. Postdrome --> migraine hangover
47
What are auras? What are cortical spreading depressions?
- Auras are disruptions that moves though the visual field due to cortical spreading depression. - Cortical spreading depressions are electrophysiological movement that corresponds to the visual disturbance speed in your vision
48
Are triggers for migraines real?
- Most people report that stress is the #1 trigger - Probable that these are just nocebo effects that are caused by previous conditioning experiences - Experiments done with these triggers do not induce migraines in laboratory settings
49
What are the 2 theories believed to cause migraines?
Vasodilation - Migraine pain throbs at the same rate as your heartbeat --> maybe its an artery problem? Neuronal - problem thought to be in the nerves locates in the dura (are inflamed) - Believed because CGRP blocking drugs reduce migraine pain
50
What are some migraine treatments?
Migraine right now - Acute drugs like triptans and gepants --> later 2 only work against migraines NOT headaches To prevent migraines overall - prophylactic drugs like MABS --> beats placebo by reducing the amount of monthly headaches by 1-2 days
51
Which health care professionals get the most pain management hours in their training? What is the problem with this?
- Vets and dentists get the most pain training - Problem is that medical school programs can only be so many hours of instruction - After this class, we have more pain training that most medical doctors

PSYC 302 Post midterm 2 (2 decks)

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