Term
| what characterizes trigeminal neuralgia (TN)? (*test question*) |
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Definition
| not constant, but intermittent, paroxysmal, "lancinating" pain - likely due to demyelination/remyelination which causes a loss of coordinated motion through the nerve. compression of the nerve by the superior cerebellar artery may also kick off the myelination problem (elongation of the vessel due to atherosclerosis). microvascular decompression is the operation devised to address this and is **the only tx that is thought to directly deal w/the cause of TN rather than the symptoms**. other tx: inflatable balloon through the foramen ovale, glycerol injection, thermal radiofrequency lesion generator - all of which deal indirectly w/the symptoms? |
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Term
| what are indications for TN sx? |
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Definition
| no response to other medications and becoming toxic or having hematological problems as a result of medications. |
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Term
| what is arachnoiditis/failed back syndrome? |
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Definition
| scarring around lumbar nerve roots, sometimes cervical due to infections, inflammatory disease, multiple spinal surgeries |
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Term
| what is RSD/complex regional pain syndrome? |
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Definition
| exact cause is unknown, but it can be caused by seemingly trivial trauma (drop something on foot, arthroscopic sx) to distal extremities and consequent nervous system overreaction. |
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Term
| what are the symptoms of RSD/complex regional pain syndrome? |
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Definition
| disproportionate pain, trophic changes, loss of hair, cold limb and shiny skin. |
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Term
| how is RSD/complex regional pain syndrome diagnosed? |
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Definition
| usually a triple phase bone scan will show abnormal bone and liquid crystal thermography is fairly diagnostic |
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Term
| how is RSD/complex regional pain syndrome treated? |
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Definition
| early on: sympathetic blocks in the stellate ganglion/lumbar plexus. later on: intra-thecal opioid pumps, spinal cord stimulation |
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Term
| how does spinal cord stimulation (SCS) work? (*test question*) |
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Definition
| the acute pain fibers (A delta) are heavily myelinated to send signals quickly. the chronic pain fibers (C fibers) are not myelinated - therefore if electrodes are placed over the dura region of the dorsal columns to keep these C fibers busy w/a low vibratory, tingling sensation - they can't send pain signals fast enough to be perceived. **endorphins from the periaqueductal gray are found to be in higher concentrations in the CSF of SCS pts.** electrodes are placed: at T9 for light pain and C3,4 for cervical pain. |
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Term
| what areas SCS work better for? |
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Definition
| it's better for appendicular pain than axial |
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Term
| what are some of the main indications for SCS? |
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Definition
| scarring from spine surgery/trauma/arachnoiditis, early stages of RSD, and scarring of a peripheral nerve |
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Term
| what are the different routes of pain medication for cancer pain? |
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Definition
| oral, transdermal (effective, no time/dose restriction, no highs/lows), IV (lifestyle limiting), and intrathecal (good for late stage CA) |
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