Podcast
Questions and Answers
What best describes acute pain?
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?
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
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?
A patient is experiencing pain after an operation. What type of pain is this?
A patient presents with non-specific back pain. This patient has a diagnosis of fibromyalgia. What type of pain is this?
A patient presents with non-specific back pain. This patient has a diagnosis of fibromyalgia. What type of pain is this?
A patient complains of shooting pains down the left arm. X-ray confirmed NO fracture. What type of pain is likely?
A patient complains of shooting pains down the left arm. X-ray confirmed NO fracture. What type of pain is likely?
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?
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?
For nociceptive pain, is this pain somatic or visceral?
For nociceptive pain, is this pain somatic or visceral?
What type of NEUROPATHIC pain is being described?
What type of NEUROPATHIC pain is being described?
What is NOT a criteria for Nociplastic Pain?
What is NOT a criteria for Nociplastic Pain?
What is the single leading cause of disability in 160 countries?
What is the single leading cause of disability in 160 countries?
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?
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?
How is the Defense Veterans Pain Rating Scale (DVPRS) different than a normal pain scale?
How is the Defense Veterans Pain Rating Scale (DVPRS) different than a normal pain scale?
There is a STRONG recommendation for the use of glucocorticoids for low back pain.
There is a STRONG recommendation for the use of glucocorticoids for low back pain.
SNRI and tricyclic antibiotics are NOT recommended for low back pain in the primary care plan.
SNRI and tricyclic antibiotics are NOT recommended for low back pain in the primary care plan.
What is true of the NC Stop Act?
What is true of the NC Stop Act?
How long does the NC Stop Act state that opioids can be prescribed for acute pain?
How long does the NC Stop Act state that opioids can be prescribed for acute pain?
NC Stop Act states that opioids must be Electronic Prescribed
NC Stop Act states that opioids must be Electronic Prescribed
There is a 30 max for opioid prescribing per NC Stop.
There is a 30 max for opioid prescribing per NC Stop.
Same provider can send one refill for opioids.
Same provider can send one refill for opioids.
STOP ACT applies to “targeted controlled substances” which are Schedule II and III opioids and narcotics
STOP ACT applies to “targeted controlled substances” which are Schedule II and III opioids and narcotics
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.
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.
PAs and NPs are required to consult the supervision physician Q60 days of a continuing treatment to ensure the treatment is still appropriate
PAs and NPs are required to consult the supervision physician Q60 days of a continuing treatment to ensure the treatment is still appropriate
There is a Mandatory Review of NC PMP when starting a patient on opioids, and then every 4 months.
There is a Mandatory Review of NC PMP when starting a patient on opioids, and then every 4 months.
Inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain
Inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain
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.
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.
Prolonged, high-frequency C fiber stimulation/ discharges can lead to reorganization of Ab fibers in neurological pain. This is called:
Prolonged, high-frequency C fiber stimulation/ discharges can lead to reorganization of Ab fibers in neurological pain. This is called:
Mental health, substance abuse, and social disparities of health can cause chronic pain.
Mental health, substance abuse, and social disparities of health can cause chronic pain.
Match the pain assessment tools
Match the pain assessment tools
What is NOT one of the top 5 compliants that patients presents with in regards to MSK?
What is NOT one of the top 5 compliants that patients presents with in regards to MSK?
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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