Chronic Pain Syndromes Overview
49 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What distinguishes primary pain from secondary pain?

  • Secondary pain occurs without any associated injury.
  • Primary pain has a known underlying condition.
  • Secondary pain is always chronic.
  • Primary pain lacks a diagnosable condition. (correct)

    • Which type of chronic pain results from a known condition?

  • Primary pain
  • Secondary pain (correct)
  • Nociceptive pain
  • Neuropathic pain

    • Which of the following conditions is classified as a primary pain condition?

  • Osteoarthritis
  • Diabetic neuropathy
  • Fibromyalgia (correct)
  • Rheumatoid arthritis

    • Which factor is associated with chronic pain that can affect quality of life?

    <p>Lower pain tolerance (D)</p> Signup and view all the answers

    What is central sensitization in chronic pain syndromes?

    <p>Increased pain perception with no physical stimulus. (C)</p> Signup and view all the answers

    Which of the following is a symptom associated with chronic pain syndrome?

    <p>Pain that radiates to nondamaged tissues (A)</p> Signup and view all the answers

    In diagnosing chronic pain, what should be the initial focus?

    <p>Determining if there is a recognizable condition (A)</p> Signup and view all the answers

    What role does neural plasticity play in chronic pain syndromes?

    <p>It strengthens pain pathways, increasing sensitivity. (A)</p> Signup and view all the answers

    What is a characteristic symptom of myofascial pain?

    <p>Presence of trigger points (A)</p> Signup and view all the answers

    What is a common cause of discogenic low back pain?

    <p>Dehydration and degeneration of the disc (B)</p> Signup and view all the answers

    Which technique is NOT appropriate for treating myofascial pain?

    <p>High-intensity interval training (B)</p> Signup and view all the answers

    What should be considered when identifying central sensitization involvement in a patient?

    <p>Patient's viewpoint and behavioral changes (C)</p> Signup and view all the answers

    How can chronic pain impact a patient's life focus and identity?

    <p>It can lead to significant changes in identity and daily activities. (A)</p> Signup and view all the answers

    What is central sensitization primarily characterized by?

    <p>Increased pain sensitivity over time (D)</p> Signup and view all the answers

    Which of these is NOT a strategy for managing chronic pain?

    <p>Engaging in avoidance behaviors (B)</p> Signup and view all the answers

    What effect do inflammatory chemicals in the nucleus pulposus have in discogenic low back pain?

    <p>They stimulate pain receptors. (A)</p> Signup and view all the answers

    Which of the following medications is commonly used to inhibit neural transmission in chronic pain management?

    <p>Gabapentin (A)</p> Signup and view all the answers

    What type of trigger point only causes tenderness upon pressure but does not spontaneously hurt?

    <p>Latent trigger point (D)</p> Signup and view all the answers

    Which of the following is an appropriate home management strategy for chronic pain?

    <p>Engaging in pain gating techniques (C)</p> Signup and view all the answers

    What behavioral change is commonly encouraged in patients with chronic pain?

    <p>Increased movement and gradual exposure to activity (C)</p> Signup and view all the answers

    What is typically NOT associated with hypomobility and chronic pain?

    <p>Increased physical flexibility (A)</p> Signup and view all the answers

    What is a hallmark characteristic of pain associated with back issues rather than radiculopathy?

    <p>Pain in the back (B)</p> Signup and view all the answers

    Which activity is most likely to aggravate symptoms associated with back pain?

    <p>Lifting heavy objects (C)</p> Signup and view all the answers

    What clinical sign is often associated with Complex Regional Pain Syndrome (CRPS)?

    <p>Coldness of the affected limb (C)</p> Signup and view all the answers

    What is a common characteristic of fibromyalgia symptoms?

    <p>Widespread muscle pain (A)</p> Signup and view all the answers

    In which demographic does fibromyalgia predominantly occur?

    <p>Females more than males (B)</p> Signup and view all the answers

    What is a typical treatment for managing symptoms of Complex Regional Pain Syndrome?

    <p>Corticosteroids and opiates (A)</p> Signup and view all the answers

    What is the recommended diagnostic approach for fibromyalgia?

    <p>Diagnosis of exclusion (B)</p> Signup and view all the answers

    Which symptom is NOT typically associated with Complex Regional Pain Syndrome?

    <p>Bilateral muscle pain (D)</p> Signup and view all the answers

    What mechanism is primarily involved in the development of fibromyalgia?

    <p>Persistent noxious stimuli and central sensitization (B)</p> Signup and view all the answers

    Which treatment option is generally considered effective for back pain but has varied results with placebo effects?

    <p>High-energy radiofrequency treatments (D)</p> Signup and view all the answers

    Cognitive neglect in CRPS refers to what phenomenon?

    <p>Feeling the limb is foreign (C)</p> Signup and view all the answers

    Which statement is true regarding the treatment of fibromyalgia?

    <p>Management strategies may vary widely (A)</p> Signup and view all the answers

    What is the expected result of the Valsalva maneuver in individuals with back pain?

    <p>Increased pain localized to the back (C)</p> Signup and view all the answers

    Which of the following is a psychological aspect that can exacerbate muscle pain in fibromyalgia?

    <p>Emotional stress (C)</p> Signup and view all the answers

    Which of the following is NOT a typical symptom of hypermobility joint syndrome?

    <p>Prolonged pain relief after activity (A)</p> Signup and view all the answers

    What is a common treatment for Ehlers-Danlos Syndrome?

    <p>Physical rehabilitation exercises (A)</p> Signup and view all the answers

    What is one of the hallmark symptoms of Marfan's Disease?

    <p>Long limbs relative to trunk length (A)</p> Signup and view all the answers

    Which of the following correctly describes a characteristic of trigeminal neuralgia?

    <p>Pain can be triggered by light touch (A)</p> Signup and view all the answers

    Which condition is most likely to result in vascular fragility?

    <p>Marfan’s Disease (D)</p> Signup and view all the answers

    What scoring tool is used to assess hypermobility in patients?

    <p>Beighton Scale (D)</p> Signup and view all the answers

    Which management strategy is indicated for pain management in conditions related to hypermobility?

    <p>Gentle aerobic conditioning like swimming (C)</p> Signup and view all the answers

    What is a potential complication of Ehlers-Danlos Syndrome?

    <p>Mitral valve prolapse (C)</p> Signup and view all the answers

    In trigeminal neuralgia, which demographic is most commonly affected?

    <p>Adults 50 years and older (C)</p> Signup and view all the answers

    What is a major risk factor for developing Marfan’s Disease?

    <p>Genetic mutations in connective tissues (D)</p> Signup and view all the answers

    Which of the following is a central symptom of hypermobility conditions?

    <p>Joins that are unusually lax (B)</p> Signup and view all the answers

    Which therapy is recommended for managing anxiety associated with connective tissue disorders?

    <p>Cognitive behavioural therapy (B)</p> Signup and view all the answers

    What type of disorder is Ehlers-Danlos Syndrome classified as?

    <p>Connective tissue disorder (C)</p> Signup and view all the answers

    In which condition might you observe easy bruising and fragile skin?

    <p>Ehlers-Danlos Syndrome (C)</p> Signup and view all the answers

    Flashcards

    Chronic Pain

    Pain that persists for 3 months or longer, regardless of underlying cause.

    Nociceptive Pain

    Pain arising from direct tissue damage, like in a muscle, joint, or bone.

    Neuropathic Pain

    Pain caused by damage to nerves, often from things like nerve compression, inflammation, or trauma.

    Nociplastic Pain

    Pain that originates from a sensitized nervous system, even without direct tissue injury.

    Signup and view all the flashcards

    Allodynia

    An increase in pain sensitivity where a normally non-painful stimulus triggers pain.

    Signup and view all the flashcards

    Hyperalgesia

    Pain that is more intense than expected, given the severity of the tissue damage.

    Signup and view all the flashcards

    Central Sensitisation

    A state where the brain and spinal cord become overly sensitive to pain signals.

    Signup and view all the flashcards

    Peripheral Sensitisation

    A state where the pain receptors in the body become more sensitive to pain signals.

    Signup and view all the flashcards

    Discogenic Low Back Pain

    Abnormal stresses and normal loss of fluid in disc → dehydration and degeneration.

    Signup and view all the flashcards

    Myofascial Pain

    Pain relating to inflammation or irritation to the muscle or fascia surrounding a muscle/group.

    Signup and view all the flashcards

    Trigger Point

    A trigger point is a hypercontracted area of muscle that feels like a pea-sized knot and often refers pain to other areas.

    Signup and view all the flashcards

    Satellite Trigger Point

    A trigger point that is localized in the referral zone of the primary trigger point.

    Signup and view all the flashcards

    Myofascial Pain - Causes

    A muscle overload or overuse injury can cause inflammation and irritation to the muscle or fascia, leading to myofascial pain.

    Signup and view all the flashcards

    Myofascial Pain Treatment

    Treatment for myofascial pain includes manual therapy, dry needling, relaxation techniques, and medical injections.

    Signup and view all the flashcards

    Discogenic Low Back Pain - Cause

    Discogenic low back pain is caused by damage to a disc and the vertebral end plates, leading to inflammation.

    Signup and view all the flashcards

    Back pain

    Pain located in the back, not radiating down the legs, often associated with specific movements like bending, lifting, or coughing.

    Signup and view all the flashcards

    Radiculopathy

    Pain caused by irritation or compression of a nerve root, leading to pain, numbness, or weakness radiating down the leg.

    Signup and view all the flashcards

    Complex Regional Pain Syndrome (CRPS)

    A group of disorders characterized by persistent pain, swelling, and changes in skin temperature and color, often following an injury.

    Signup and view all the flashcards

    CRPS Types

    CRPS type 1 occurs without a clear nerve injury, while CRPS type 2 is associated with a specific nerve injury.

    Signup and view all the flashcards

    Fibromyalgia

    A debilitating condition with widespread muscle pain, fatigue, and sleep problems, often accompanied by tender points.

    Signup and view all the flashcards

    Tender Points

    Tender points are specific areas of pain located in the muscles, often found in people with fibromyalgia.

    Signup and view all the flashcards

    Valsalva Maneuver in Back Pain

    A positive Valsalva maneuver in back pain indicates pain specifically in the back, not radiating down the legs. This is a key sign to differentiate back pain from radiculopathy.

    Signup and view all the flashcards

    Radiofrequency Treatment

    A procedure where a high-energy radiofrequency current is applied to heat and destroy nerves, aiming to relieve pain.

    Signup and view all the flashcards

    Tenderness and Hypertonicity

    In back pain, tenderness and tightness in the muscles are common signs.

    Signup and view all the flashcards

    Abnormal Movement

    Abnormal movement patterns, like a catching sensation, can indicate a problem with back movement.

    Signup and view all the flashcards

    Valsalva Maneuver for Radiculopathy vs Back Pain

    This maneuver can help differentiate between back pain and radiculopathy, as it should primarily provoke local back pain in back pain cases, not leg pain.

    Signup and view all the flashcards

    MRI for Back Pain

    MRI is typically recommended for back pain only in specific situations like recent trauma, older age with possible fracture, or neurologic concerns.

    Signup and view all the flashcards

    Corticosteroid Injections for Back Pain

    Corticosteroid injections are often used for back pain, but their effectiveness is debated, with evidence suggesting they might not be significantly better than placebo.

    Signup and view all the flashcards

    Disproportionate Pain in CRPS

    Pain that is disproportionate to the inciting event in CRPS, meaning the pain is much more severe than the injury would normally cause.

    Signup and view all the flashcards

    Temperature Differences in CRPS

    Changes in skin temperature between the affected and unaffected limbs are a common finding in CRPS, indicating sympathetic involvement.

    Signup and view all the flashcards

    Benign Hypermobility Joint Syndrome

    A disorder where connective tissue is abnormally loose, leading to joint hypermobility, easy bruising, and other musculoskeletal symptoms.

    Signup and view all the flashcards

    Beighton Scale

    A scoring system used to assess joint hypermobility, where a score of 4 or higher indicates hypermobility.

    Signup and view all the flashcards

    Ehlers-Danlos Syndrome

    A group of genetic disorders that affect connective tissues, causing joint hypermobility, skin fragility, and other symptoms.

    Signup and view all the flashcards

    Marfan's Syndrome

    A genetic disorder affecting connective tissues, leading to musculoskeletal, cardiac, and ocular abnormalities.

    Signup and view all the flashcards

    Trigeminal Neuralgia

    A condition characterized by severe, episodic facial pain, typically affecting one side of the face.

    Signup and view all the flashcards

    Pain later in the day

    Pain that occurs later in the day or following physical activity, often seen in hypermobility syndromes.

    Signup and view all the flashcards

    Fidgeting

    A common symptom in hypermobility syndromes where people tend to fidget and walk rather than standing still.

    Signup and view all the flashcards

    Postural adaptations

    Postural changes seen in hypermobility, such as leaning against walls or sitting in specific positions to support joints.

    Signup and view all the flashcards

    Multidisciplinary treatment

    A type of treatment focusing on education, cognitive therapy, gentle exercise, and relaxation techniques for pain management.

    Signup and view all the flashcards

    Cognitive behavioral therapy (CBT)

    A type of therapy that helps people understand and change their thoughts and behaviors related to pain.

    Signup and view all the flashcards

    Gentle exercise

    A type of exercise that involves slow, controlled movements to improve joint mobility and flexibility.

    Signup and view all the flashcards

    Gentle aerobic conditioning

    A form of exercise that strengthens muscles, improving overall fitness while being gentle on joints.

    Signup and view all the flashcards

    Relaxation exercises

    Techniques like meditation or deep breathing to reduce stress and pain.

    Signup and view all the flashcards

    Gentle chiropractic and STW (trigger point) therapy

    A type of treatment that focuses on releasing tension in muscles and restoring proper joint alignment.

    Signup and view all the flashcards

    Mitral valve prolapse

    A common complication of hypermobility, where the heart valves don't close properly.

    Signup and view all the flashcards

    Study Notes

    Chronic Pain Syndromes: Overview

    • Chronic pain is defined as pain lasting ≥ 3 months.

    • Primary pain lacks an underlying condition, while secondary pain stems from a known condition.

    • Chronic pain significantly reduces quality of life. NICE estimates 48% of the UK population experiences it.

    Pain Categories

    • Nociceptive pain arises from tissue injury (e.g., muscle, joint, bone).

    • Neuropathic pain results from nerve damage (e.g., demyelination, laceration, crush injuries, viral infections).

    • Nociplastic pain stems from a sensitized nervous system.

    • Central sensitization involves the brainstem and spinal cord, leading to amplified pain signals.

    • Peripheral sensitization affects nociceptors in the affected and surrounding areas, making them more responsive to stimuli.

    Central Sensitization (CS)

    • Brainstem releases inflammatory chemicals, increasing pain perception.

    • Nociceptors fire with less stimulus.

    • Nociceptors in adjacent areas become activated.

    • Neural plasticity strengthens pain pathways.

    • CS patients often perceive pain as more threatening, have lower pain tolerance, and employ maladaptive coping mechanisms.

    Primary Pain Conditions

    • Fibromyalgia, headache, complex regional pain syndrome (CRPS), non-specific lower back pain, sacroiliac joint (SIJ), lumbar, and neck/shoulder pain.

    Secondary Pain Conditions

    • Osteoarthritis, headache, temporomandibular joint (TMJ) disorders, diabetic neuropathy, endometriosis, rheumatoid arthritis (RA), and psoriatic arthritis.

    Diagnosing Chronic Pain

    • Establish an underlying condition first.

    • Assess patient's symptoms comprehensively.

    • Consider potential differentials and employ relevant tests to confirm or exclude a diagnosis.

    • Consider the patient's perspective, fears, coping mechanisms, and impact on daily activities to identify potential CS involvement.

    Treatment Approaches

    • Explain the biomechanical cause of the problem and address patient concerns and fears.

    • If there any concerns about an underlying condition, how the possibility is excluded?

    • Explain the lack of correlation between pain and imaging findings.

    • Educate patients about central and peripheral sensitization, emphasizing that pain isn't necessarily "made up" or "exaggerated".

    • Treat the underlying musculoskeletal condition appropriately.

    • Implement strategies to manage hypersensitivity, such as low force techniques and gradually increasing stimulation.

    • Address maladaptive illness perceptions, and encourage movement and activity, starting at a low level and gradually increasing.

    • Incorporate both pharmacological (e.g., pregabalin, gabapentin) and non-pharmacological approaches (pain gating techniques, mindfulness, cognitive behavioural therapy, rehabilitation).

    Myofascial Pain

    • Pain resulting from muscle or fascia inflammation/irritation.

    • Characterized by trigger points (hypercontracted areas of muscle).

    • Latent trigger points are tender only on compression, while active trigger points are spontaneously painful or triggered by movement.

    • Trigger points can refer pain to other areas.

    Discogenic Low Back Pain

    • Chronic low back pain caused by disc damage and endplate changes.

    • Disc degeneration is common with age, but not always indicative of pain.

    • Inflammatory chemicals in the nucleus pulposus can lead to a cycle of inflammation, potentially with involvement of sinuvertebral nerves.

    • Treatment may include corticosteroid injections, radiofrequency treatments or surgery.

    Complex Regional Pain Syndrome (CRPS)

    • Characterized by persistent noxious stimuli leading to amplified pain.

    • CRPS Type 1 has no nerve injury evident, while CRPS Type 2 does.

    • It typically manifests in a distal extremity and presents with burning, aching, throbbing, and tingling pain.

    Fibromyalgia

    • Characterized by widespread muscle pain, fatigue, concentration difficulties, and joint stiffness without deformity.

    • Fibromyalgia is associated with central nervous system changes, sensitizing the nervous system to pain.

    • Numerous factors, including genetics, past trauma, immune responses, and environmental factors, contribute to the development of fibromyalgia.

    Hypermobility Hallmarks

    • Widespread joint pain, typically worsening later in the day or after activity.

    • Postural adaptations (e.g., leaning against walls, sitting in odd positions).

    • Fidgeting/increased movement.

    Benign Hypermobility Joint Syndrome (BHS)

    • A connective tissue disorder, characterized by generalised laxity.

    • Diagnosed through the Brighton criteria and the Beighton scale.

    Ehlers-Danlos Syndrome (EDS)

    • A heterogeneous group of genetic disorders affecting connective tissue.

    • Characterized by joint hypermobility.

    Marfan's Syndrome

    • A connective tissue disorder with significant impacts on musculoskeletal, cardiac, and ocular systems.

    Trigeminal Neuralgia

    • Characterized by severe, episodic facial pain, affecting one or both branches of the trigeminal nerve.
    • Two major classifications: idiopathic (possible ischemia to the nerve) and symptomatic (actual nerve damage).

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    Explore the intricacies of chronic pain syndromes in this quiz. Understand the different categories of pain, including nociceptive, neuropathic, and nociplastic pain. Delve into concepts of central and peripheral sensitization to enhance your comprehension of how pain affects quality of life.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser