1 Treatment of Central Sensitization

Question 1

How does stress play a role in central sensitization?

Answer 1

Stress affects cortical and noradrenaline in the brain

then increases excitatory synapses in hippocampus, amygdala, prefrontal cortex

Question 2

What occurs when there is increased signaling during centralization

Answer 2

Better nerve firing in learning new task (learning)

Produces more fascicles and receptors pre/post synaptic cleft

How the body learns pain and stress increases potentiation

Question 3

how does stress affect the neruochemistry of the brain?

Answer 3

Decreased GAG neurotransmission
Decreased Serotonergic activity

Less inhibition from periphery

Central sensitization (higher levels of CNS)

Question 4

What are techniques to deal with stress

Answer 4

Mindfullness, meditation, Schultz relaxation (make one area heavy while sitting in comfortable position)

This alters pain matrix

Leads to less pain

Question 5

How does physical activity affect the pain matix?

Answer 5

Correlation with less areas of pain matrix firing, the more you can move the less threatening the areas they are feeling

Exercise helps!

Question 6

Pain contingent

Answer 6

I stop doing activity once pain gets worse
Telling pt to stop when it hurts will reinforce positive feedback with pain

Tells them activity is bad. Explain to patient to not be afraid of pain

Question 7

Time contingent

Answer 7

Stimulating pain matrix until flaring
impacted long term potentiation

Show the pain we’re not giving into it

Question 8

How does exercise account for central sensitization?

Answer 8

goals based on graded progression meeting certain levels

Careful with isometric exercises (can increase nociception - dont encourage pain matrix)

Eccentric activities can involve tissue damage

Have recovery periods within and following exercise sessions

Question 9

Typical treatment program flow

Answer 9

PNE > Stress management > activity/self management (baseline) > Grading (GA/GET) > Recovery