Pm&r Pocketpedia - Pain Medicine And The Spine

Front 1

What is the difference between dysesthesia and parasthesia?

Back 1

Both are spontaneous or evoked abnormal sensations, however dysesthesia implies that the sensation is unpleasant.

Front 2

What is the difference between hyperalgesia and allodynia?

Back 2

Both involve a pain response due to a stimulus, however allodynia involves a stimulus that does not normally evoke pain.

Front 3

What is the difference between the way insurance companies and health care workers define chronic pain?

Back 3

The pain must last >6 months for insurance companies to define it as chronic. We should define it as pain exceeding the usual course of injury or disease.

Front 4

This syndrome involves learned behavioral patterns to maintain secondary gains such as narcotic meds or time off work.

Back 4

Chronic Pain Syndrome
They perceive themselves as disabled in order to justify their behavior.

Front 5

This scale involves respondents marking the location on a line corresponding to the amount of pain they are experiencing. It is more reliable than numerical scales.

Back 5

10 cm visual analogue scale (VAS)

Front 6

Why do massage or TENS units applied pain locally provide relief? What theory id this based on?

Back 6

Gate Control Theory: activation of large sensory afferents inhibit transmission of pain signals through small pain fibers via interactions in the dorsal horn.

Front 7

The terms "reflex sympathetic dystrophy" and "causalgia" have been replaced by what?

Back 7

Complex Regional Pain Syndrome (CRPS)

Front 8

What is the difference between Type 1 and Type 2 CRPS?

Back 8

Type 1 is not, while Type 2 is associated with nerve injury.

Front 9

You 23yo female patient comes to clinic 6 months after her MVA associated BI. She has had a complete recovery other than some occasional difficulty multi-tasking at work. She mentions that her right arm has been hurting her though. On exam, you find that she has mild swelling in the arm and hand, with hyperemic splotches in her palm. She pulls away complaining of burning. What are you thinking may be wrong?

Back 9

CRPS: burning pain, allodynia, temeprature or color changes, edema, hair and/or growth changes.

Front 10

What are the 3 stages of CRPS?

Back 10

Hyperemic Stage: few weeks to six months; burning pain, allodynia, edema, warmth, smooth skin

Dystrophic Stage: cold, worsening of edema and pain, decreased function, onset of osteoporosis

Atrophic Stage: weakness, loss of ROM, pain is better

Front 11

What is the difference between myofascial pain syndrome and fibromyalgia?

Back 11

There is no fatigue or systemic symptoms prominent as in fibromyalgia. Also, F:M less.
MPS - 3:1
FM - 10:1

Front 12

What percentage of people with LBP for >1 month have a definable disease or injury?

Back 12

15%

Front 13

Define low back pain.

Back 13

Pain between the costal margins and the gluteal folds lasting >24 hours.

Front 14

What are the five Waddell signs of non-organic low back pain?

Back 14

1- Regionalization - regional weakness/sensory loss
2- Overreaction - exaggerated pain response to non-painful stimuli.
3- Simulation - pain on axial loading or sham rotation of the spine
4- Distraction - inconsistent findings during distraction
5- Tenderness - non-anatomic or superficial

Front 15

How would you determine the validity of low back pain based on Waddell's signs?

Back 15

at least 3 positive signs; must be chronic back pain, not acute.

Front 16

How does the severity or lack there of, of lumbar lordosis, effect your differential diagnosis in a patient with low back pain

Back 16

Increased lordosis may indicate spondylolisthesis, while decreased lordosis may indicate disc or vertebral body collapse.

Front 17

Failure of bedrest to relieve intensity of severe low back pain should make you suspicious of what?

Back 17

malignancy

Front 18

Describe a positive SLR test.

Back 18

Pain radiation, below the knee, between 35 and 70 degrees of hip flexion. Pain at >70 deg is more likely joint pain.

Front 19

Which special test has the best predictive value of a true lumbar radiculopathy?

Back 19

Crossed-SLR: pain in the symptomatic/non-raised leg

Front 20

Criteria for lumbar stenosis diagnosed on imaging.

Back 20

Vary. Typically <7-<10mm AP diameter or a cross-sectional area of 70mm squared on myelogram.

Front 21

The most common symptom associated with lumbar stenosis.

Back 21

Decreased walking distance. (neurogenic claudication) SLRs usually negative

Front 22

Your patient complains of generalized low back pain, sometimes radiating down his legs but never below the knee. Pain exacerbated by extension and relieved by flexion. What is the most likely diagnosis?

Back 22

Lumbar zygapophyseal (facet) arthropathy

Front 23

What is the difference between spondylosis and spondylolisthesis?

Back 23

Sponylosis is a defect in the pars interarticularis (congenital or acquired) whereas spondylolisthesis is subluxation of one vertebra on another (L5S1)