1
Q
Definition of neuropathic pain
A
- pain caused by lesion (trauma/surgery) or disease (MS) of somatosensory nervous system
2
Q
How might neuropathic pain occur?
A
- centrally or peripherally
3
Q
How can neuropathic pain be used to classify pain?
A
- as both a mechanism or diagnosis
4
Q
Common peripheral neuropathic pain diagnoses
A
- trigeminal neuralgia
- peripheral nerve injury
- painful polyneuropathy
- post-herpetic neuralgia
- painful radiculopathy
5
Q
Common central neuropathic pain diagnoses
A
- pain with brain injury
- central post-stroke pain
- pain with multiple sclerosis
- pain with spinal cord injury
6
Q
Transduction with neuropathic pain
A
- spontaneous activity in primary afferents
7
Q
Transduction/transmission with neuropathic pain
A
- excitation of ascending nociceptive signals from periphery, spinal cord and brain
- nociceptors have changes in ion function and expanded receptor fields (sensitization)
8
Q
Modulation with neuropathic pain
A
- impaired sensory inhibition
9
Q
What is the main diff btwn peripheral and central sensitization?
A
- peripheral: increased transduction of nociceptive signals from periphery to spinal cord
- central: increased transmission of nociceptive signals from spinal cord to brain
10
Q
Location of pain with neuropathic pain
A
- corresponds to location innervated by injured/diseased tissue
11
Q
Neuropathic pain quality
A
- pins and needles
- tingly
- stinging
- electrical
- numb
12
Q
Review sensory changes
A
- allodynia
- paresthesia
etc.
13
Q
Sensory changes of neuropathic pain
A
- touch aggravates pain (ie. from physical exam or clothing)
- people can experience simultaneous numbness and increased sensitivity
14
Q
Temporal features of neuropathic pain
A
- spontaneous pain (ectopic activity of nociceptors)
- onset of pain doesnt correlate with onset of nerve disease/injury *CAN BE DELAYED
15
Q
Intensity of neuropathic pain
A
- moderate to severe
- doesnt correlate with neurological tissue damage
16
Q
Relieving factors of neuropathic pain
A
- not relieved by first line pain treatments such as rest, ice heat, NSAIDS, acetaminophen
17
Q
Treatment for neuropathic pain
A
- focuses on managing symptoms not treating underlying disease
- complex pharmacology and medial interventions
- unique PT interventions such as graded motor imagery, mirror therapy, sensory retraining
18
Q
Definition of nociplastic pain
A
- 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 NS causing pain
19
Q
Structural changes to nociceptors in the periphery with nociplastic pain
A
- nociceptors have larger receptor fields
20
Q
Functional changes to nociceptors in the periphery with nociplastic pain
A
- peripheral sensitization (increased sensitization, lower thresholds)
- increased inflammatory mediators
21
Q
Structural changes to 2nd order nociceptive neurons in the spinal cord with nociplastic pain
A
- larger receptor fields
22
Q
Functional changes to 2nd order nociceptive neurons in the spinal cord with nociplastic pain
A
- central sensitization (increased sensitization, lower thresholds)
- spontaneous activity
23
Q
Functional changes to 3rd order nociceptive neurons with nociplastic pain
A
- central sensitization
24
Q
Functional changes to modulation with nociplastic pain
A
- loss of descending inhibition (imp for dampening pain of every day things such as stubbing toe)
- increased descending facilitation
25
Structural changes in the organization of the cortex with nociplastic pain
- painful areas are enlarged explaining spread of pain/sensory changes
26
Temporal summation
- successive increase in AP in a neuron due to rapid, repeated stimulation causing increased pain perception
27
Clinical example of temporal summation
- if you repeatedly test pin prick in a painful area, it will be perceived as increasingly painful with successive pricks
28
What does the "wind up" of the spinal cord mean?
- enhanced response to nociceptors due to repeated noxious stimuli
- increasingly more nociceptive signals transmitted with repeated transduction
29
Which type of sensitization is dominant with nociplastic pain?
- central
30
Pain location of nociplastic pain
- widespread
- doesnt correlate with anatomical structure
31
Provoking factors of nociplastic pain
- because of CS, many stimuli can provoke pain including non-noxious stimuli
32
Quality of pain with nociplastic pain
- many descriptors
33
Severity of nociplastic pain
- fibromyalgia and CRPS are associated with high intensity ratings
- severity of pain not correlated with extent of tissue damage
34
Temporal factors of nociplastic pain
- pain at rest
- evoked or spontaneous
35
Treatment of nociplastic pain
- not focused on treating tissues
- targets the nervous system as pain itself as the disease
- PT includes education, active/exercise based strategies, self-management
36
Sensitization of normal nociceptive pain
NONE
37
Sensitization of inflammatory nociceptive pain
- peripheral
38
Sensitization of neuropathic pain
either
39
Sensitization of nociplastic pain
- either (dominant=central)
40
What is mixed pain?
- pain that initially starts as nociceptive and /or neuropathic and transitions to nociplastic over time
- pain with features of multiple pain mechanisms that co-occur
- pain at multiple body sites that each have distinct mechanisms contributing to the personal overall pain experience
41
Pain with OA
- typically thought of as nociceptive pain
- inflammatory pain
- evidence of mixed pain mechanisms
42
Allodynia
- pain due to a stimulus that does not normally provoke pain
43
Paresthesia
- an abnormal sensation, whether spontaneous or evoked
44
Dysesthesia
- an unpleasant abnormal sensation, whether spontaneous or evoked
45
Hyperesthesia
- increased sensitivity to stimulation, excluding the special senses
ie. wearing a light shirt feels painful
46
Hypoesthesia
- decreased sensitivity to stimulation, excluding the special senses
47
Hyperalgesia
- increased pain from a stimulus that normally provokes pain
ie. a pin prick causes a disproportionately severe amount of pain
48
Hypoalgesia
- diminished pain in response to a normally painful stimulus
49
Anesthesia
- no sensation in response to a stimulus
PT1 Pain science
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