Flashcards in Week 3 Deck (49)
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1
Serum sickness
-joint pain as an allergic response
-can occur up to 6 week after taking Rx drug (esp antibiotics)
2
Inflammatory bowel disease
-can present with new onset of joint symptoms
-usually large joints (often a single knee or hip)
-UC and CD can also present with these symptoms
3
Infectious arthritis
-local response to infection
-lyme disease, STDs, hep b, rubella,
-staph, strep, gonocci
-major risk factors; over 80, DM, IV drugs, catheters, RA, oa
4
Reactive arthritis
-nongonoccal urethritis, conjunctivitis, multiple joint involvement ("triad")
-often causes inflammation along tendons (plantar fasciitis, sacroiliits)
5
Radicular pain
-results from direct irritation of axons or a spinal nerve o rneurons in the DRG
-dermatome, sclerotome, myotome
6
Radiating pain
-pain spreads or fans out from the originating point of pain
7
Referred pain
-activation of nociceptive free nerve endings of the nervous system in somatic or visceral tissue
8
Radiculopathy
-neurologic state in which conduction along a spinal nerve or its root is blocked
-numbness or weakness is present instead of pain
9
GI pain if obstruction
-increases with peristalsis or ingestions
-decreases with vomiting or BM
10
GI pain if acid related
-pain relieved by food or other neutralizing material
-pain worse when stomach is empty and secreting acid
11
GI pain if other organs involved
-pain may increase with certain positions that increase internal abdominal pressure
12
Gall bladder position of relief
-slight trunk flexion
13
Kidney position of relief
-flexion and side bending towards involved kidney
14
Pancreas position of relief
-sitting up and leaning forward OR knees to chest
15
5 P's of pain at rest with ischemia
1. pain
2. pallor
3. puleslessness
4. paresthesia
5. paralysis
PVD when in unilateral extremity
-burning, shooting, pain, may have paresthesias
16
Acute vs. chronic nigh pain
Can't lie on involved side=acute
30-60 in=sub-acute
>2hr=chronic
17
Pain lag time
5 to 10 mins between beginning activity and onset of symptoms = vascular/claudication
-immediate pain or symptoms: more likely MS
18
Chronic pain
-greater than 3 months
-6 weeks should be cut off for clinical progress
19
Chronic pain vs. systemic disease
Chronic pain: dull and persistant, usually history of precipitating injury/event
Systemic: more acute with recent onset, sharp, knife-like, deep
20
2 Reasons visceral pain is not well localized
1. Innervation of the viscera is multisegmental
2. There are few nerve receptors in these structures
21
Somatic-somatic reflex responses
Bruise on the leg can cause knee pain
22
Somatovisceral reflex responses
Biomechanical dysfunction at 10th rib can cause gallbladder changes
23
Viscero-somatic reflex response
Gallbladder impairment can result in 10th rib; pelvic floor dysfunction can lead to incontinence; heart attack causes arm or jaw pain
24
Viscero-viscero reflex
Occurs when pain or dysfunction in one organ causes symptoms inanother
25
S/S that accompany visceral pain
- ANS response such as change in vitals, unexplained perspiration (diaphoresis), skin pallor
26
Neuropathic pain
results from damage or pathophysiologic changes of the peripheral or central nervouse system
27
Causes of neuropathic pain
1. acute nerve root irritation (severe, burning, shooting, constant)
2. Chronic nerve root irritation (annoying, nagging)
28
Other s/s of neuropathic pain
-not alleviated by opiates or narcotics
-no muscle spasm
-meds used are often antidepressants, anti-convulsants, antispasmoditcs, adrenergics, anesthetics
29
Referred pain description
-usually well localized, but doesn't have sharply defined borders and can spread or radiate from its origin
-often accompanied with muscle hypertonus
30
Tension Pain
-organ distention
-makes it difficult to find a comfortable position
31
Inflammatory pain
-inflammation of the viscera or parietal peritoneum
-may cause deep/boring pain
-people seek positions of quiet with little movement
32
Ischemic pain
-sudden, intense, constant, progressive
-not relieved by position or analgesics
33
Myofascial pain
-myalgia can be present in anxiety/depressive disorders
-can be a side effect of drugs
-can be symptom of underlying disorder
-joint pain commonly accompanies this
34
Muscle tension
-prolonged muscular contraction or co-contraction results in local ischemia, increased cellular metabolites, pain
35
Muscle spasms
-sudden, involuntary contraction of a muscle or group of muscles
36
Trigger points: jump sign
person physically withdraws from the pressure on teh point
37
Trigger points: active
Refer pain locally or to another location
-can cause pain at rest
-fatigue faster and recover more slowly
38
Trigger points: latent
Do not cause spontaneous pain, but generate referred pain when the affected muscles are put under pressure, palpated or strained
39
Trigger points: key
Have pain-referral pattern along nerve pathways
40
Trigger points: satellite
-set off by key trigger points
41
Pain catastrophizing scale
-negative view of the pain experience/expecting the worst to happen
-person can already be in pain or just be expecting pain
-13 item self report
42
McGill Pain Questionnaire
-measures subjective pain experience in quantitative form
-sensory and affective word descriptors
-helps therapist identify the source of pain (visceral, neurogenic, somatic, pscyhosomatic)
43
Illness Behavior Syndrome
-pain in absence of an identified source of disease or pathologic condition
-present most often in people with chronic pain
-dramatization of complaints, progressive dysfunction, drug misuse, progressive dependency on others
44
Symptom magnification syndrome
-conscious: malingering
-unconscious: illness behavior
-self-destructive, socially re-inforced behavioral pattern
45
Waddell's Nonorganic Signs
3 or more positive signs = nonmovement dysfunction
-non-mechanical, pain focused
-poor outcomes
-does not suggest absence of pain, but behavioral response to pain
-does not confirm malingering
46
5th vital sign
PAIN
47
Most common sites of referred pain from systematic disease
-chest
-back
-shoulder
-scapula
-pelvis
-hip
-groin
-SI joint
48
Verbal descriptor scale (VDS)
-most sensitive and reliable among older adults, including those with mild/mod cognitive impairment
49
