Clin Med - Chronic Pain
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Questions and Answers

What best describes acute pain?

  • known cause, less than 1 month (correct)
  • known cause, 1-3 months
  • known or unknown cause, greater than 3 months
  • nociception

    • What best describes pain?

  • Sensory discomfort experiences with tissue damage
  • An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage (correct)
  • Physical events that lead to actual tissue damage, not a personal experience, but a known response to an action
  • Pain serves an adaptive role, it may have adverse effects on function and social and psychological well-being

    • Match the pain physiology

    Transduction = Converting stimulus to electrical signal, travel up the ascending pathway Transmission = Processing in the dorsal root ganglion Modulation = Activation of descending pain pathway Perception = Awareness of pain

    A patient is experiencing pain after an operation. What type of pain is this?

    <p>Nociceptive/ Inflammatory</p> Signup and view all the answers

    A patient presents with non-specific back pain. This patient has a diagnosis of fibromyalgia. What type of pain is this?

    <p>Nociplastic</p> Signup and view all the answers

    A patient complains of shooting pains down the left arm. X-ray confirmed NO fracture. What type of pain is likely?

    <p>Neuropathic</p> Signup and view all the answers

    A patient suffered from a fractured humerus bone following a hard fall. The patient now complains of numbness and tingling in the distal limb. What type of pain does this all under?

    <p>Mixed Pain</p> Signup and view all the answers

    For nociceptive pain, is this pain somatic or visceral?

    <p>Somatic = arisingfrombone/joint/muscles/connectivetissue/ etc Visceral = arisingfrominternalorgans(abdomen,liver, pancreas, etc) Somatic = Localized pain described as achy, dull, throbbing, sore Visceral = Diffuse, not well-localized, often has a referral pattern; May be described as: gnawing, squeezing, cramping</p> Signup and view all the answers

    What type of NEUROPATHIC pain is being described?

    <p>Peripheral = injury or damage to a peripheral nerve (arising from the spinal roots and distal to them; peripheral nervous system) Peripheral = May be described as: burning, throbbing, stinging Central = injury or damage to the spinal cord or brain (central nervous system) Central = May be described as: shooting, squeezing/aching and might include a large part of the body</p> Signup and view all the answers

    What is NOT a criteria for Nociplastic Pain?

    <p>Show clinical signs of pain hyposensitivity</p> Signup and view all the answers

    What is the single leading cause of disability in 160 countries?

    <p>Low back pain</p> Signup and view all the answers

    A patient describes an electric shock-like sensation that occurs on flexion of the neck. This sensation radiates down the spine, often into the legs, arms, and sometimes to the trunk. What is this called?

    <p>Lhermitte Sign</p> Signup and view all the answers

    How is the Defense Veterans Pain Rating Scale (DVPRS) different than a normal pain scale?

    <p>It uses faces, emotions, numbers and word descriptions</p> Signup and view all the answers

    There is a STRONG recommendation for the use of glucocorticoids for low back pain.

    <p>False</p> Signup and view all the answers

    SNRI and tricyclic antibiotics are NOT recommended for low back pain in the primary care plan.

    <p>True</p> Signup and view all the answers

    What is true of the NC Stop Act?

    <p>Patient can be prescribed 7 days of narcotics for post-op pain</p> Signup and view all the answers

    How long does the NC Stop Act state that opioids can be prescribed for acute pain?

    <p>5 days</p> Signup and view all the answers

    NC Stop Act states that opioids must be Electronic Prescribed

    <p>True</p> Signup and view all the answers

    There is a 30 max for opioid prescribing per NC Stop.

    <p>True</p> Signup and view all the answers

    Same provider can send one refill for opioids.

    <p>True</p> Signup and view all the answers

    STOP ACT applies to “targeted controlled substances” which are Schedule II and III opioids and narcotics

    <p>True</p> Signup and view all the answers

    PAs and NPs must consult with the supervising physician when prescribing Schedule II or III medications in the field of Pain Management or if their use is >30 days.

    <p>True</p> Signup and view all the answers

    PAs and NPs are required to consult the supervision physician Q60 days of a continuing treatment to ensure the treatment is still appropriate

    <p>False</p> Signup and view all the answers

    There is a Mandatory Review of NC PMP when starting a patient on opioids, and then every 4 months.

    <p>False</p> Signup and view all the answers

    Inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain

    <p>True</p> Signup and view all the answers

    Abnormal excitability can elevate sensitivity to stimulus and lead to ___________ which lower threshold within spinal cord and cellular membranes and increase in receptive field within brain.

    <p>peripheral sensitization</p> Signup and view all the answers

    Prolonged, high-frequency C fiber stimulation/ discharges can lead to reorganization of Ab fibers in neurological pain. This is called:

    <p>central sensitization</p> Signup and view all the answers

    Mental health, substance abuse, and social disparities of health can cause chronic pain.

    <p>True</p> Signup and view all the answers

    Match the pain assessment tools

    <p>OPQRST = Onset, Provocation, Quality, Region/Radiation, Severity, Timing QISS TAPED = Quality, Impact, Site, Severity, Temporal characteristics, Aggravating factors, Past response, Expectations, Diagnostics SOCRATES = Site, Onset, Character, Radiation, Associations, Time course, Exacerbating factors, Severity A = a</p> Signup and view all the answers

    What is NOT one of the top 5 compliants that patients presents with in regards to MSK?

    <p>Ankle and Hands</p> Signup and view all the answers

    Study Notes

    Pain Physiology

    • Acute pain is a normal response to tissue damage or inflammation
    • Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage

    Types of Pain

    • Post-operative pain is an example of acute pain
    • Non-specific back pain with a diagnosis of fibromyalgia is an example of chronic pain
    • Shooting pains down the left arm with no fracture is likely neuropathic pain
    • Numbness and tingling in the distal limb after a fractured humerus bone is an example of neuropathic pain

    Nociceptive Pain

    • Nociceptive pain can be somatic (pain from skin, muscles, bones, and joints) or visceral (pain from organs)

    Neuropathic Pain

    • Neuropathic pain is caused by abnormalities in the peripheral or central nervous system
    • Electric shock-like sensation on flexion of the neck radiating down the spine is an example of neuropathic pain, known as Lhermitte's sign

    Nociplastic Pain

    • Nociplastic pain is pain that arises from altered nociception, independent of actual or potential tissue damage
    • Inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain

    Defense Veterans Pain Rating Scale (DVPRS)

    • DVPRS is a pain rating scale used to assess pain in veterans

    Treatment of Pain

    • Glucocorticoids have a strong recommendation for use in low back pain
    • SNRI and tricyclic antibiotics are not recommended for low back pain in primary care
    • The NC Stop Act states that opioids can be prescribed for acute pain for up to 7 days, with a maximum of 30 pills per prescription
    • Opioids must be electronically prescribed, and the same provider can send one refill
    • PAs and NPs must consult with the supervising physician when prescribing Schedule II or III medications in the field of Pain Management or if their use is >30 days

    Pain Assessment Tools

    • Adequate pain assessment is crucial for effective pain management
    • Mental health, substance abuse, and social disparities of health can cause chronic pain

    Miscellaneous

    • Abnormal excitability can elevate sensitivity to stimulus and lead to central sensitization
    • Prolonged, high-frequency C fiber stimulation/discharges can lead to reorganization of Ab fibers in neurological pain, known as synaptic plasticity

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