persistent / chronic pain

Question 1

What is persistent pain?

Answer 1

Pain that persists or recurs for longer than 3 months.

Question 2

What are the two classifications of persistent pain according to WHO?

Answer 2

• Persistent primary pain
• Persistent secondary pain

Question 3

What is the impact of persistent pain on individuals?

Answer 3

• Physical health
• Mental health
• Social life
• Home life
• Ability to work

Question 4

What is the main purpose of pain?

Answer 4

Protection and essential warning sign.

Question 5

What influences the pain people experience?

Answer 5

• Past experiences
• Stress levels
• Worry
• Fatigue

Question 6

Define persistent primary pain.

Answer 6

Pain where no underlying condition adequately accounts for the pain or its impact.

Question 7

What is persistent secondary pain?

Answer 7

Pain where an underlying condition adequately accounts for the pain or its impact.

Question 8

What is the relationship between pain and scans or X-rays?

Answer 8

Pain often results from factors that do not show up on scans or X-rays.

Question 9

What is central sensitisation?

Answer 9

Occurs in the central nervous system and involves increased pain sensitivity.

Question 10

What is peripheral sensitisation?

Answer 10

Occurs in the peripheral nervous system and can involve hyperalgesia.

Question 11

List some non-modifiable factors that influence pain.

Answer 11

• Genetics

Question 12

List some modifiable factors that influence pain.

Answer 12

• Sleep
• Stress
• Fear
• Anxiety
• Past pain experiences
• Education of pain
• Social messaging
• Cultural factors
• Healthcare advice

Question 13

What is the relationship between persistent pain and memory?

Answer 13

Persistent pain can cause brain fog and short-term memory loss.

Question 14

What is the relationship between pain and sleep?

Answer 14

Poor sleep increases the likelihood of developing persistent pain.

Question 15

How are stress, anxiety, and depression related to pain?

Answer 15

They are linked to low self-efficacy, which can increase pain.

Question 16

What factors can increase the likelihood of persistent disabling pain?

Answer 16

• Negative mindset
• Passive coping mechanisms
• Negative emotional responses

Question 17

What are common beliefs about low back pain (LBP)?

Answer 17

• Caused by injury or tissue damage
• Poor posture can cause LBP
• Wear & tear causes LBP
• Can occur with exercise
• Gets worse with age
• Exercising in pain causes harm

Question 18

What is the fear avoidance model?

Answer 18

A model that explains why chronic low back pain leads to disability, indicating two pathways: recovery or persistent pain.

Question 19

What is pain catastrophising?

Answer 19

Magnifying the threat of pain and feeling helpless in its presence.

Question 20

What is hypervigilance?

Answer 20

A state of increased alertness that makes a person sensitive.

Question 21

What is self-efficacy in the context of pain?

Answer 21

An individual’s beliefs about their ability to manage pain.

Question 22

What is the biopsychosocial model?

Answer 22

A perspective viewing pain as a dynamic interaction among biological, psychological, and social factors.

Question 23

What are some resources to understand the bio-psychosocial approach to back pain?

Answer 23

• YouTube videos by Lorimer Moseley
• Podcasts on pain and the brain

Question 24

types of chronic primary pain

Answer 24

• nociceptive
• neuropathic
• nociplastic

Question 25

nociceptive

Answer 25

pain associated with tissue injury or damage or even potential damage

Question 26

neuropathic

Answer 26

pain associated with injury or disease of nerve tissue (eg shingles, radiculopathy, diabetic neuropathy

Question 27

nociplastic

Answer 27

pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage, causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain (CRPS, fibromyalgia, NSLBP)

Question 28

risk factors of nociplastic pain

Answer 28

exact cause (or causes) of nociplastic pain remain unknown the following have been shown to increase the risk: * female sex, * early-life stressors, * trauma, * poor sleep, * genetics and epigenetics * Inactivity

Question 29

what screening questionaires could be appropriate for chronic pain

Answer 29

* The 2011 Fibromyalgia Survey Criteria * PHQ 2 and PHQ 9 * The Central Sensitisation Inventory * Pittsburgh Sleep Quality Index * Multidimensional Fatigue Inventor

Question 30

what clues might be suggestive of nociplastic pain syndrome

Answer 30

* chronic pain over 3 months that is in multiple body regions * evoked hypersensitivity in the region of the pain (hyperalgesia and/or allodynia) * In addition to comorbidities such as sleep disturbance, fatigue, mood or memory problems, many doctor visits or investigations) Poor or no response to conventional analgesics (including opioids)

Question 31

what is sensitisation

Answer 31

sensitisation is an increased responsiveness of nociceptive neurons to normal input