Amplified Pain syndromes

Question 1

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

Answer 1

pain

Question 2

in central sensitization (APS), ______ are inhibited, causing an amplified sensation

Answer 2

inhibitory interneurons

Question 3

who is typically affected

Answer 3

females 9-18

mature, excels, pleaser, perfectionist, worrier, sensitive

Question 4

pain with non-noxious stimulus

Answer 4

allodynia

Question 5

Exam findings with APS

Answer 5

LEs affected more often than UE
weakness
poor cardiopulmonary endurance
poor muscle endurance
allodynia
positive review of systems

Question 6

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

Answer 6

Symptoms associated with APS

Question 7

autonomic changes with APS

Answer 7

temp changes
swelling
and or skin color changes

Question 8

stress increases pain

Answer 8

pain increases stress

Question 9

“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

Answer 9

complex regional pain syndrome

Question 10

Sensory disturbances associated with CRPS

Answer 10

Allodynia/hyperalgesia
autonomic dysfunction
motor dysfunction

Question 11

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

Answer 11

conversion disorder

Question 12

inability to stand or walk, but an ability to move the legs with lying down or sitting

Answer 12

astasia-abasia

Question 13

limb locking
uncontrollabe shaking
lack or ROM
Foot drop
conversion gait/difficulty walking
fluctuating weakness
pseudoseizures
numbness/paraysis
blindness/dearness

Answer 13

examples of conversion disorder

Question 14

treatment recommendations for APS

Answer 14

4 prong approach
physical activity
desensitization
stress management
decrease attention to pain
Focus on improving function, function will return before pain fully resolves

Question 15

physical activity recommendations

Answer 15

45 min of intense non stop exercise per day
15 min aerobic
30 min strengthening
HEP of 20 exercises

Question 16

increased pain response to noxious stimuli

Answer 16

hyperalgesia

Question 17

types of sensation

Answer 17

light touch
deep pressure
vibration
temperature

Question 18

recommended desensitization

Answer 18

5 times a day for 5-10 min

Question 19

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)

Answer 19

functional disability inventory

Question 20

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

Answer 20

canadian occupational performance measure (COPM

Question 21

assesses the sub max level of functional capacity

patient chooses pace and intensity of exercise to walk as far as possible for 6 min

Answer 21

6 min walk test

Question 22

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

Answer 22

bruininks-Oseretsky test of motor proficiency II (BOT2)