Amplified Pain syndromes Flashcards
an unpleasant sensory and emotional experience associated with actual or potential tissue damage
pain
in central sensitization (APS), ______ are inhibited, causing an amplified sensation
inhibitory interneurons
who is typically affected
females 9-18
mature, excels, pleaser, perfectionist, worrier, sensitive
pain with non-noxious stimulus
allodynia
Exam findings with APS
LEs affected more often than UE weakness poor cardiopulmonary endurance poor muscle endurance allodynia positive review of systems
pain lasting longer than 3 mo absence of underlying medical condition normal lab results 5 or more tender points fatigue/sleep disturbances numbness or tingling of extremities pain modulated by stress depression/anxiety autonomic changes abdominal pain blurry vision chest pain diarrhea, dizziness, headaches, memory deficits, vomiting, palpitations
Symptoms associated with APS
autonomic changes with APS
temp changes
swelling
and or skin color changes
stress increases pain
pain increases stress
“cold blue foot”
chronic condition affecting the nerves and blood vessels (generally no identifiable nerve damage)
pain disproportionate to the initial event
sensory disturbances
typically occurs after trauma that is often trivial
more common in LE in peds
complex regional pain syndrome
Sensory disturbances associated with CRPS
Allodynia/hyperalgesia
autonomic dysfunction
motor dysfunction
inconsistent with any neurological or musculoskeletal injury
symptoms are unconscious manifestations of psychological stressors
the patient cannot control the symptoms
consistently inconsistent
can coexist with APS
conversion disorder
inability to stand or walk, but an ability to move the legs with lying down or sitting
astasia-abasia
limb locking uncontrollabe shaking lack or ROM Foot drop conversion gait/difficulty walking fluctuating weakness pseudoseizures numbness/paraysis blindness/dearness
examples of conversion disorder
treatment recommendations for APS
4 prong approach physical activity desensitization stress management decrease attention to pain Focus on improving function, function will return before pain fully resolves
physical activity recommendations
45 min of intense non stop exercise per day
15 min aerobic
30 min strengthening
HEP of 20 exercises
increased pain response to noxious stimuli
hyperalgesia
types of sensation
light touch
deep pressure
vibration
temperature
recommended desensitization
5 times a day for 5-10 min
measures patient’s perception of functional abilities
15 item self report inventory
5 point likert scale ranging form 0-4 (total score of 60 higher = greater disability)
functional disability inventory
measures patient’s personal goals and their satisfaction with their performance on these goals
patients determine goals and rate level of importance, current performance and satisfation (total score 1-10)
change of 2 points is considered clinically and statistically significant
canadian occupational performance measure (COPM
assesses the sub max level of functional capacity
patient chooses pace and intensity of exercise to walk as far as possible for 6 min
6 min walk test
assesses motor performance - fine motor control, manual coordination, body coordination and strength and agility
standardized, norm referenced measure
normed on typically developing children ages 4-21 years
10-15 min to administer each composite
bruininks-Oseretsky test of motor proficiency II (BOT2)
