B2 L25 Treatment of pain, management and patient facilitation

Question 1

What are the 9 questions in Jonathan Hill and the STarT Back trial from Keele (UK) for stratified or stepped care?

Answer 1

1. My back pain has spread down my leg(s) at sometime in the last 2 weeks
2. I have had pain in the shoulder or neck at some time in the last 2 weeks
3. I have only walked short distances because of my back pain
4. In the last 2 weeks, I have dressed more slowly than usual because of back pain
5. It’s not really safe for a person with a condition like mine to be physically active
6. Worrying thoughts have been going through my mind a lot of time
7. I feel that my back pain is terrible and it’s never going to get any better
8. In general I have not enjoyed all the things I used to enjoy
9. Overall, how bothersome has your back pain been in he last 2 weeks?

Question 2

In the Jonathan Hill and the STarT Back trial from Keele (UK) for stratified or stepped care, what do the results mean?

Answer 2

Question 3

Use manual therapy with ______ and______ (_______ rehab)

Answer 3

exercise; education; multimodal

Question 4

What are moderators?

Answer 4

adjust the effect of the intervention

Question 5

What are mediators?

Answer 5

a variable outcome of intervention

Question 6

What are the 3 things in pain experience?

Answer 6

1. Top-down moderators
2. Central mediators
3. Peripheral mediators

Question 7

What central mediators in charge of?

Answer 7

• Changes in spinal excitability
• Changes in motor function
• Decrease in cortical excitability
• Decreased activation in brain pain processing areas
• Decreased activation of facilitatory/increase in inhibitory pathwyas
• Changes in resting state brain functional connectivity

Question 8

What are peripheral mediators in charge of?

Answer 8

Biomechanical:

• Increase ROM
• Decrease passive stiffness and active stiffness

Neurophysiological:

• Changes the concentration of inflammatory and pain mediator substances

Question 9

What are top-down moderators?

Answer 9

• Habituation
• Graded exposure to mechnical stimuli
• Sensory discrimination training
• Cognitions
• Expectations
• Placebo/meaning response
• Contextual factors
• Therapist effect

Question 10

What is the treatment effect via desensitisation versus temporary analgesia?

Answer 10

Question 11

How does specific motor retraining affect cortical mapping?

Answer 11

Question 12

How does specific motor retraining affects quadriceps vector?

Answer 12

Question 13

How does specific motor retraining affects medial-lateral motor unit synchrony?

Answer 13

Question 14

To change behaviour, people will need to progress through 5 steps. What are they?

Answer 14

1. Receive information
2. Understand
3. Hope, motivation and decision
4. Commitment, confidence and resilience for challenges/barriers
   
   • Will benefit be worth the effort?
   • Is behaviour change high enough priority their current situation?
5. Taking action.

Question 15

What are 2 things to consider when managing pain and managing the body in a biopsychosocial framework?

Answer 15

1. Patient understanding: they will need to know enough to self-manage as much as reasonable. How to interpret symptoms ranging from inconsequential through to a flare-up of pain, and what activities are appropriate.
2. A biopsychosocial framework for rehabilitation may consider the domains of load, complexity and context

Question 16

In a biopsychosocial framework for rehabilitation, what is load?

Answer 16

emphasises the biological: refers to peak forces, repetitions, duration of exposure etc. , which will influence factors such as mechanotransduction for tissue adaptation, motor control, and perception of self-efficacy

Question 17

In a biopyschosocial framework for rehabilitation, what are the 3 keys things to consider?

Answer 17

1. Load
2. Complexity
3. Context

Question 18

In a biopsychosocial framework for rehabilitation, what is complexity?

Answer 18

emphasises the psychological: consider aspects such as the number of degrees of freedom with a movement, components in a task sequence, or aspects such as dual tasking and time demands, which increases the psychological load

Question 19

In a biopsychosocial framework for rehabilitation, what is context?

Answer 19

emphasises the social: such as doing the task in a safe environment, through to environments that are more stressful e.g. sporting or artistic performance, or workplace

Question 20

In therapeutic exercise, what are 3 effects of specific motor retraining?

Answer 20

1. Cortical mapping shifts.
2. Quads vector. Visual feedback reduces pain.
3. Medial-lateral motor unit synchrony increases - less pain, better function.

Question 21

When working with patients, what are 3 things that physios must avoid doing?

Answer 21

1. Telling people what to do
2. Arguing the point
3. Scare tactics without offering hope

Understand patient’s journey through these steps. Not just give info.

Question 22

What are 2 benefits of stratified management? What does stratified care allow the patient to have?

Answer 22

1. Increase health benefit at a lower cost.
2. Results in satisfaction, reduced pain/fear/depression, better health, less absenteeism.

Stratified management allocates patient to different treatment pathways based on their prognostic risk for chronicity.