Flashcards in pain syndromes Deck (49)
Affects more Americans than diabetes, heart disease and cancer combined
the most common cause of long-term disability
Most common reason Americans access the health care system
this kinda of pain alerts person to possible injury/condition
this kind of pain is persistant, signals keep firing for weeks or years
There may be an initial trigger (injury or condition, serious infection, arthritis, cancer, etc.), but
many suffer w/o history of injury or condition
this kind of pain adversely affecting a person’s life physically, emotionally, and mentally
Can alter body at the cellular level
chronic pain includes
headaches, LBP, cancer, arthritis, neurogenic, and psychogenic (not due to past disease or injury)
Can be based on pain physiology, intensity, temporal characteristics, type of tissue affected, or syndrome
Pain physiology (nociceptive, neuropathic, inflammatory)
Intensity (mild-moderate-severe; 0-10 numeric pain rating scale)
Time course (acute, chronic)
Type of tissue involved (skin, muscles, viscera, joints, tendons, bones)
Syndromes (cancer, fibromyalgia, migraine, others)
Caused by damage, injury, or inflammation to body tissue
Usually described as a sharp, aching, or throbbing pain
Usually associated with acute conditions
Associated with chronic pain
Occurs when there is damage, change, or problems to the peripheral nerves or CNS
Usually described as prickling, tingling or burning
Generally responds poorly to pain tx
A patient reports a pricking, tingling and burning sensation on the dorsum of her left hand. What type of pain is this patient describing?
a. Acute pain
b. Nociceptive pain
c. Chronic pain
d. Neuropathic pain
what is gate control theory?
Pain impulses are “influenced” by a gating mechanism in the dorsal horn
Stimulating touch or movement sensation can close the gate, limiting pain impulse transmission
"non-painful sensations override painful sensations"
gating mechaniskm is controlled by
Gating mechanism is controlled by the activity in the large and small fibers
Large-fiber (A–alpha or proprioception/movement, A-beta or touch) activity inhibits (or closes) the gate
Whereas small fiber activity (pain) opens the gate
When gate is closed, small diameter pain fibers do not excite the dorsal horn transmission neuron
If pain information reaches a threshold that exceeds inhibition
It “opens the gate” and pathways to experience pain
Gating mechanism is influenced by nerve impulses that descend from the brain
3 influences on opening and closing the gate:
Amount of activity in the pain fibers
Amount of activity in other peripheral fibers
Messages that descend from the brain
neurophysiology of pain modulation: circles consist of what in the brain?
Circuit consists of periaqueductal gray (PAG) matter in the upper brain stem, locus coeruleus (LC), the nucleus raphe magnus (NRM) and nucleus reticularis gigantocellularis (Rgc)
neurophysiology of pain modulation: contribute to what pathway?
this inhibits what?
the descending pain suppression pathway,
inhibiting incoming pain
neurophysiology of pain modulation: opiods interact with what?
this causes what?
Opioids interact with the opiate receptors at different CNS levels, causing secondary changes which lead to neuronal electrophysiological change and modulation of ascending pain information
neuropathic pain causes
Infections & viral conditions
chronic pain treatment
Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, etc.
Some physicians use placebos
Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification
Chronic pain sufferers found to often have lower than normal levels of endorphins in spinal fluid
acupuncture activates what systems?
Acupuncture & electro-acupuncture may activate endorphin systems
acupuncture is believed to stimulate what fibers? what do these fibers inhibit and enhance?
Believed to stimulate A-delta fibers mediating inhibition of pain impulses, and enhance descending pathway inhibition from midbrain
post-acupuncture treatment has shown increased levels of what in CSF?
Post-acupuncture Tx shown to increase levels of endorphins in cerebrospinal fluid
What is CRPS?
Complex Regional Pain Syndrome (CRPS) type I and II is a multifactorial disorder that is associated with an aberrant host response to tissue injury
30% of CRPS sufferers experience persistent pain and impairment for 2-6years following onset
CRPS can be resistant to therapies making management challenging for clinicians
mechanism of CRPS
1) original injury initates a pain impulse carried by sensory nerves to CNS
2) pain impulses trigger impluses in sympathetic system which returns to the original site of injury
3) sympathetic impluse triggers inflammatory response causing the vessels to spasm leading to swelling and increased pain
4) pain triggers another response, establishing a cycle of pain and swelling
Formerly known as Reflex Sympathetic Dystrophy (RSD)
Pain characterized as constant, extremely intense, and out of proportion to the original injury
Typically accompanied by swelling, skin changes, extreme sensitivity, and can often be debilitating
Usually affects one or more of the four limbs but can occur in any part of the body
In over 70% of the victims it spreads to additional areas
Progressive disease of the ANS, and more specifically, the Sympathetic Nervous System
75% of those affected are women
Pain is primary component:
Described as the most pain ever experienced
“Imagine your hand was doused in gasoline, lit on fire, and then kept that way 24/7, and you knew it was never going to be put out”