Assessment 3 Flashcards
Explain central sensitisation
As your pain has persisted, your nervous system which involves all of your nerves, your brain and your spinal cord become more sensitive, this is called central sensitisation
For example - think about your nervous system being a home alarm system. Normally it only sounds an al when there is danger present, like a burglar, but with central sensitisation the home sell system becomes extremely sensitive and might start blaring the alarm when a pet walks by or a leaf blows in the wind. Your nervous system has become to hyper vigilant that even things that are usually considered safe like gently moment or light touch can cause pain
Explain peripheral sensitisation
Peripheral sensitization happens when the nerves in a specific area in the both become extra sensitive
This means they react more strongly to things that wouldn’t normally cause pain or make pain feel worse than usual
It happens because of tissue damage or inflammation which releases certain chemicals in your body that turn up the volume on pain signals
This sensitivity I is the body’s way of trying to protect itself, but sometime the nerves stay on high alert even after the original injury has healed. The good news is that there are ways to help calm the nerves and reduce the sensitivity
Short term management strategies for chronic pain
Discussing an interprofessional team
Manual therapy
Setting 1-2 short goals to get a win (enact referrals, physical activity, socialising, reflect on DIMSIM)
PROMs
+ patient pain education of what pain is and why you have had it for so long
What is exercise induced hypoalgesia
Decreased inflammation
Decreased intensity
Decreased disability
Increased pain tolerance
How does exercise induced hypoalgesia work
Increased brain derived neurotrophic factor helps regulate neuronal growth and repair
Mechanotransduction - cells convert mechanical stim into biomech signals which lead to cellular responses like tissue healing and remodelling
And combo of what exercise is best for CP
Cardio, resistance, flexibility is best
But something is better than nothing
What is motivational interviewing
A communication technique aimed at guiding and enhancing a persons motivation for change
Help the pt come to the conclusion themselves that change should happen they can’t just be told
Reducing pain isn’t a good enough reason to change. For many it’s the hope of doing things again that their pain stops them from doing
What is pain neuroscience education
Changing beliefs about pain
Reconceptualising pain (broader physiological understanding)
Learn coping strategies
This leads to improved pain beliefs and behaviours (top down)
What is a good education strategy for PNE
Elicit provide elicit
Elicit what the pt knows
Ask permission to comment on what they know
Provide education that addresses errors
Elicit Joe this new info has changed their thoughts and beliefs
What strategy is used to reduce fear and avoidance behaviour and challenge negative pain related beliefs?
Graded exposure
What is gradedexposure?
Gradually exposes individuals to a fear or painful activity in structured and controlled manner
What PROM is a good way to measure if greeted exposure is working
FABQ
What are the parameters for graded ex
3X per week, 20% increase, for six weeks
What are some important factors of graded exposure
Reassurance
Important to stick to it no matter what
Increases should be scheduled not response based on
If there is a flare up, reduce increases to smaller increments ie 10%
Important to equip pts with info about how flare ups might happen
Coping strategies specific to pt
Written plan so they don’t have to remember all the info
Explain the relationship between thought and emotions and the pain experience
Living with a. Chronic condition can be really challenging and it’s completely understandable to experience a wide range of emotions about it.
Out kinds and bodies are deeply connected which means the way we think and feel can influence our pain experience
For example when we are feeling stressed worries or frustrated our muscles might tense up and our nervous system can become more sensitive to pain. On the other hand when we feel calm supported or hopeful our bodies may feel a bit more at ease which can help reduce the intensity of pain
What is CBT
Based on the idea that people are not disturbed about the negative events in their life but the beliefs about the events.
Help people review their thoughts and behaviours and decide whether they are helpful or not
If unhelpful they use education and other strategies to challenge them with the aim of behaviours change
What PROM is useful for whether CBT would be indicated
PCS
Explain bottom up pain physiology to a teacher
Nociceptors detect noxious stimuli
Pain signals carried by a delta fibres and C fibres to the dorsal horn
They travel up spinothalamic tract and spinoretivular tract to brain stem and thalamus
Sensory cortex determines the location and intensity of the pain
Prefrontal cortex and limbos system contribute to emotional and cognitive experience
Explain top down approach to a teacher
The PAG and RVM rostral ventromedial medulla sends inhib signals down the spinal cord
Neurotransmitters (endorphins, serotonin, NE) suppress pain signals at the spinal cord level
Cognitive processes like attention expectation and mood play a role on perception
How do endorphins affect pain
Bind to opioid receptors and prevent glutamate and substance P release
How does serotonin affect pain
Modulates SC interneurons
How does NE affect pain
Activates andronergic receptors that reduce pain transmission
How do bottom up strategies work
Address pain gate at dorsal horn (interneuron) (inhibitory)
How do top down strategies work
Pharmacology - SSRIS and opioids alter neurotransmitters
Education - cognitive modulation of pain
CBT - negative thoughts about pain and modulation
