Pain Management and Fibromyalgia Overview

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Questions and Answers

What is the main purpose of pacing in pain management?

To avoid feeling rushed and conserve energy (correct)

To promote continuous activity regardless of discomfort

To completely eliminate the sensation of pain

To increase the intensity of activities throughout the day

Which treatment caution is particularly relevant for older adults?

They have a lower risk of GI bleeding

They require higher doses of medications

They metabolize drugs more quickly

They metabolize drugs more slowly (correct)

In treating clients with substance abuse problems and pain, what is a significant approach to take?

Ignore the client's history of substance abuse

Establish a treatment plan that alleviates pain and minimizes withdrawal symptoms (correct)

Create a rigid treatment plan without adjustments

Focus solely on medication prescriptions

What is a key feature of polyneuropathies compared to mononeuropathy?

It affects two or more nerves Signup and view all the answers

Which of the following is a common psychological symptom experienced by patients with fibromyalgia?

Anxiety Signup and view all the answers

What effect do endogenous opioid peptides have when released during acupuncture?

They decrease pain perception Signup and view all the answers

What is one potential physiological abnormality linked to fibromyalgia?

Increased Substance P in the spinal cord Signup and view all the answers

What demographic group is most frequently diagnosed with fibromyalgia?

Women aged 30-50 Signup and view all the answers

Which of the following symptoms is NOT commonly associated with fibromyalgia?

Joint swelling Signup and view all the answers

What is the primary reason for difficulty in identifying the origin of pain in fibromyalgia patients?

Pain is often indistinct among muscle, joint, or soft tissue Signup and view all the answers

What is a characteristic feature of mild radiculopathy?

Sensory loss and pain without motor deficits Signup and view all the answers

Which treatment option involves the removal of the lamina?

Laminectomy Signup and view all the answers

Which of the following best describes moderate radiculopathy?

Sensory loss and pain with mild motor deficits Signup and view all the answers

What is the primary cause of radiculopathy symptoms?

Pinching of a nerve root in the spinal column Signup and view all the answers

What should be prioritized in the management of radiculopathy?

Monitoring for complications Signup and view all the answers

Which symptom is specifically associated with nerve root compression?

Loss of sensation Signup and view all the answers

What key technique is recommended for client teaching in radiculopathy cases?

Application of corsets and braces Signup and view all the answers

Which factors contribute to an increased risk of developing radiculopathy?

Family history and smoking Signup and view all the answers

What diagnostic method can determine the level of nerve dysfunction?

Nerve conduction studies Signup and view all the answers

What is an effective preventative measure against radiculopathy?

Maintaining a healthy weight and proper body mechanics Signup and view all the answers

What is a key feature of Guillain-Barre Syndrome in terms of its progression?

It leads to symmetrical ascending paralysis primarily affecting the lower limbs. Signup and view all the answers

Which condition is NOT commonly known to cause nerve damage?

Tuberculosis Signup and view all the answers

What complication can occur as a result of peripheral neuropathy?

Diabetes management difficulties Signup and view all the answers

What type of neuropathy is characterized by difficulty in detecting temperature changes?

Sensory neuropathy Signup and view all the answers

What is a common initial symptom of Guillain-Barre Syndrome?

Paresthesia in the feet Signup and view all the answers

What happens during the recovery phase of Guillain-Barre Syndrome?

Remyelination occurs in a proximal-to-distal pattern. Signup and view all the answers

Which symptom is associated with autonomic neuropathy?

Blood pressure fluctuations Signup and view all the answers

What is a significant risk associated with diabetic peripheral neuropathy?

Gangrene Signup and view all the answers

What is a critical intervention for cauda equina syndrome to prevent permanent damage?

Surgical decompression within 48 hours Signup and view all the answers

Which of the following is a misconception about palliative care?

Palliative care is limited to end-of-life situations Signup and view all the answers

In what scenario is palliative care most appropriately utilized?

When a disease is considered incurable or progressive Signup and view all the answers

What is one of the main goals of palliative care?

To maintain pain control and avoid suffering Signup and view all the answers

Which of the following best describes the role of culture in palliative care?

Cultural beliefs significantly influence patient care preferences Signup and view all the answers

Which of the following is an effective posture to maintain while standing?

Using both feet slightly apart and maintaining an upright position Signup and view all the answers

What might be a cause of palliative pain related to cancer?

Direct invasion of nerves or organs by the disease Signup and view all the answers

Which of the following best describes the lifting technique recommended to prevent injury?

Using leg muscles to lift rather than back muscles Signup and view all the answers

Study Notes

Pain & Sensory Perception

Pain is defined as "whatever the experiencing person says it is, existing whenever they say it does" (International Pain Society, 2018).
Pain is shaped by various factors, including the patient's expression and the impact of pain on their life.
Psychological distress can lead to ineffective pain management or reliance on pharmacological methods.
It's crucial to consider the patient holistically.

Main Types of Pain

Nociceptive Somatic: Pain related to nociceptive activity in the skin (sharp, aching, throbbing).
Nociceptive Visceral: Pain originating from organs/body cavities (gnawing, cramping, dull).
Neuropathic: Pain caused by injury to central, peripheral, or autonomic nerves (burning, prickling, tingling, numbness).

Pain Transmission

Pain originates in one or more body parts, but its perceived location may differ.
Pain signals travel through nerves to the spinal cord.
The brain processes these signals and interprets them as pain.
Endorphins released by the brain can reduce pain.

Assessment

Onset: When did the pain begin?
Provocative/Palliative: Does pain worsen with movement? Does anything relieve it? Can any successful treatments be described?
Quality: How does the pain feel? Describe the intensity, and type of pain.
Region: Where is the pain located?
Severity: Rate the pain on a scale of 0-10.
Treatment/Timing: What treatments have worked in the past? Is the pain continuous or intermittent?
Understanding: Patient history, and past experiences with pain.
Values: Acceptable pain levels and patient goals of care.

Pain Rating Scales

Facial expressions (grimacing, furrowed brow, etc.)
Clenched jaw/teeth
Grasping blankets
Rigid body
Unusual breathing patterns
Agitation/irritability
Moaning/calling out
Not responding to voice/withdrawn
Flinching to touch
Guarding painful areas
Kicking, restless legs, rocking

Fibromyalgia

Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and tender points.
Patients often experience poor sleep, morning stiffness, irritable bowel syndrome, and anxiety.
Women are 9 times more likely to be diagnosed than men.
Ages 30-50 are commonly affected, and having a family history is a possible risk factor.
The exact cause is unknown; however current understanding suggests alterations in neurotransmitter levels and central processing of nociceptive pain input.

Nerve Root Compression

Normal Disc: Spinal cord, Neural foramen, Nerve Root, Nucleus pulposus, and Disc annulus.
Degenerated Disc: Normal disc structures are damaged/deteriorated.
Bulging Disc: The Nucleus pulposus is pushing into the annulus, but not breaking through the annulus fibrosis.
Herniated Disc: The nucleus pulposus has broken through the annulus fibrosis.
Radiculopathy: Pain, numbness, and weakness caused by nerve root compression in the spine.
Symptoms: Pain, numbness, tingling, weakness, loss of reflexes, changes

Diagnosis

Patient history and physical examination (muscle strength and reflexes, pain with movement)
Imaging (X-ray, CT, MRI)
Nerve conduction studies (measures nerve function)

The Spine

Regions: Cervical, Thoracic, Lumbar, Sacrum and Coccyx

Cauda Equina Syndrome

Emergency condition related to nerve root compression below the spinal cord.
Symptoms: Impaired bladder and bowel control, sexual dysfunction, saddle anesthesia, and limb impairment.
MRI required immediately.
Surgical decompression needed within 48 hours to prevent permanent damage.

Palliative Pain Management

Palliative care focuses on relieving pain and other distressing symptoms in patients facing life-threatening illness. It aims to maximize comfort and quality of life.
It can be given alongside curative treatments.
It does not hasten or postpone death but focuses on goals of pain control, avoiding prolonged suffering, a sense of control, easing family burden, making clear decisions and completing life tasks.
Assessing the patient's physical, spiritual, emotional, and social needs is crucial.

Barriers to Palliative Care

Lack of resources
Lack of knowledge
Provider bias
Misunderstanding
Restrictive eligibility criteria
Reluctance

Palliative Assessment

A comprehensive history is essential.
A complete physical, psychological, social, and spiritual assessment.
Appropriate investigations.

Basic Principles of Pain Management

Delay in treatment should be avoided.
Oral routes are generally preferred for medication.
Analgesics should be used as per the need for regular pain relief.
Breakthrough pain should be addressed.
Educate patients on pain management and the use of pain scales.

WHO Pain Ladder

A systematic approach to pain management.
Provides guidance on appropriate pain medications based on pain severity.

Complications

Peripheral Neuropathy: Nerve damage.
Diabetic Foot: Foot complications when diabetes results in nerve damage.
Guillain-Barre Syndrome (GBS): Rapidly progressing, potentially fatal, nerve condition.
Trigeminal Neuralgia (TN): Uncommon, extremely painful facial pain.

Special Populations

Addressing pain management for individuals with substance abuse disorders requires a dual diagnosis approach.

Peripheral Neuropathy

Neuropathy affects one or more nerves (mononeuropathy or polyneuropathy).
Symptoms depend on the type of nerve damaged.
Symptoms can include muscle weakness, twitching, tremors, sensory dysfunction, and autonomic dysfunction.
Common causes include autoimmune conditions (e.g., lupus), diabetes, infections, and certain medications.

Complications of Peripheral Neuropathy

Burns and skin injury
Falls
Infection
Heart and circulatory system problems
Diabetic foot ulcers
Gangrene

GBS:

A rapidly progressing and potentially fatal nerve condition.
Characterized by symmetrical ascending paralysis, loss of reflexes, and often triggered by infections (viral or bacterial)
Requires constant monitoring of the respiratory system and may require mechanical ventilation.

Trigeminal Neuralgia

A chronic painful condition.
Characterized by severe electric shock-like facial pain outbreaks.
Often starts as brief attacks (seconds to minutes).

Bell's Palsy

An acute facial nerve disorder causing paralysis.
Majority of patients recover in 3 weeks.
It is often associated with emotional stress and trauma.

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Description

This quiz explores important concepts in pain management, specifically focusing on fibromyalgia and related treatment options. It covers various symptoms, psychological aspects, and specific demographic considerations related to fibromyalgia patients. Learn about underlying conditions and treatment strategies that can aid in managing pain effectively.