06-01: Pain

Question 1

Definition of Pain

Answer 1

• An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
• Warning sign for potential tissue damage

Question 2

Categories of Pain (2)

Answer 2

• Acute

- Chronic

Question 3

Acute Pain

Answer 3

• Lasts less than 6 weeks
• Lasts as long as noxious stimulus exists
• Sub-acute pain lasts between 7-12 weeks

Question 4

Chronic Pain

Answer 4

• Lasts beyond time of healing: > 12 weeks
• Activation of abnormal neurological responses
• Lasts after stimulus ceases
• Associated with physical, psychological, social dysfunction

Question 5

Healing process of pain (12 weeks)

Answer 5

• Full 12 weeks to heal
• 50% at 2 weeks
• 80% at 6 weeks
• 100% at 12 weeks

Question 6

Types of pain (4)

Answer 6

• Referred
• Trigger Points
• Radiating Pain
• Sclerotomes

Question 7

Referred Pain

Answer 7

• Experience pain in one area, but the injury is in another area
• Can refer joint-to-joint
• Most common joint-to-joint: hip-to-knee
• Can refer from peripheral nerve to its distal intervention (Radiating pain)
• Can refer from an organ to outside tissues

Question 8

Trigger Points

Answer 8

Hyperirritable area of muscle that, when activated, becomes painful and may refer pain to areas that follow a specific pattern associated with a particular point.

Question 9

Radiating Pain

Answer 9

• Pain caused by irritation of nerves and nerve roots
• Ex: Sciatic Nerve: Pain from sciatica radiates from the buttock down the leg and can travel as far as the feet and toes

Question 10

Sclerotomes

Answer 10

• Deep somatic pain
• A segment of bone that is innervated by a spinal segment
• Similar to dermatomes

Question 11

Pain Assessment (4)

Answer 11

• Visual Analogue Scale
• Numeric Scale
• Pain Charts
• Questionnaires (Ostwestry, McGill, Dallas, Rowland Morris LBP)

Question 12

Goals of Therapy

Answer 12

• Directed toward reducing pain
• Pain can inhibit pt’s ability to function, prevent participation in therex, cause other complications
• PTs/PTAs encourage body to heal using movement (therex)
• Modatlities can assist in reducing pain; allows a quicker return to function

Question 13

Pain Descriptors

Answer 13

• Gives better idea of what causes pain: jt, tissue, muscle

- Ex: sharp, dull, throbbing, stinging, achting, burning, localized, generalized

Question 14

Sensory Receptors

Answer 14

Sensory nerve ending designed to detect various stimuli

Question 15

Meissner’s Corpuscles

Answer 15

Light Touch

Question 16

Pacinian Corpuscles

Answer 16

Deep Pressure

Question 17

Merkel’s Corpuscles

Answer 17

Slow response to deep pressure (ex: hair follicle activity controls as depressed, pushed on)

Question 18

Ruffini Corpuscles

Answer 18

Skin - touch, tension, heat

Can detect change in posiiton (joint)

Question 19

Krause’s End Bulbs

Answer 19

React to decrease in temperature and touch

Question 20

Nociceptors

Answer 20

Respond to noxious stimuli, tissue damage

Question 21

Endogenous Opioids

Answer 21

• Opiate-like neuroactive peptide substances made by the body
• Produced and released when we experience pain
• Released by nerves traveling from brain to spinal cord
• Have analgesic properties
• Block the passage of noxious stiimuli
• Reduces sense of pain

Question 22

Types of Endongenous Opioids (2)

Answer 22

• Endorphins and Enkephalins

- Enkephalins inhibit depolarization of nociceptor nerve fibers

Question 23

Neural transmission of pain

Answer 23

Sensory receptors –> Afferent fibers (towards brain) –> Dorsal horn of spinal cord –> Brain –> Efferent fibers (away from brain) –> Motor response

Question 24

Neurotransmitters

Answer 24

Substances that pass info from one neuron to another

Question 25

Gate Theory of Pain: Ascending

Answer 25

• Stimulus –> Dorsal horn of spinal cord –> Pain message encounters “nerve gate”
• Stimulates fibers so pain fibers blocked; can potentially shut gate
• Short term (as long as stimulus exists)

Question 26

Open Gate (Gate Theory)

Answer 26

Pain message gets through –> pain is received

Question 27

Closed Gate (Gate Theory)

Answer 27

Pain message doesn’t reach brain –> no pain is received

Question 28

Gate Theory (Thin, Thick fibers)

Answer 28

• Pain travels over smaller, thin fibers (“C” fibers)
• Touch, pressure, vibration, movement travels over large thick fibers (A Beta Fibers) - stimulate sensation to inhibit feeling of pain
• Both fibers act on the inhibitory neuron - thin inhibits, thick stimulates
• Movement also stimulates enkephalin release