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PHTY2101 EOS > B2 L26 Chronic pain management and Patient facilitation > Flashcards

B2 L26 Chronic pain management and Patient facilitation Flashcards

1
Q

What are the 4 characteristics of radicular pain?

A
  1. Mechanical and/or chemical irritation of a peripheral nerve (includes DRG / cauda equina)
  2. may be persistent and moderate-severe
  3. may have non-mechanical behavior (pain at rest and various positions) but also displays mechanical behavior with neural tissue provocation tests
  4. may have neurological deficits
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2
Q

What are the 4 characteristics of peripheral neuropathic pain

A
  1. Disease or lesion of the peripheral nervous system, characterized by
  2. persistent, moderate-severe pain, with a
  3. non-mechanical pain behavior
  4. may have neurological deficits associated.
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3
Q

What is the difference between referred and radicular pain?

A
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4
Q

What are the contributors and effects of chronic pain?

A
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5
Q

What are the 8 factors in the symptom cycle? (in no specific order)?

A
  1. Disease
  2. Stress
  3. Pain
  4. Tense muscles
  5. Anger, fear, frustration
  6. Depression
  7. Shortness of breath
  8. Fatigue
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6
Q

Assessment in MSK

A

ADD

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7
Q

Based on Peter O’Sullivan, why must you be careful what you say and also listen?

A

Explored the language used by patients and healthcare professionals to describe low back pain and any potential effect on patient perceived prognosis. Patients believe that “wear and tear” and “disc space loss” indicated a progressive loss of structural integrity. “deterioration […] spine is crumbling” and “collapsing […] discs wearing out.” The use of degenerative terms by patients was associated with a poor perceived prognosis (P < 0.01). Explanation of radiological findings to patients presents an opportunity to challenge unhelpful beliefs, thus facilitating active treatment strategies.

AFFECTS HOW A PATIENT PERCEIVES A DIAGNOSIS/PROGNOSIS GIVE RESPECT- LISTEN TO PATIENT

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8
Q

Ben Darlow said there is impact of therapist communication on patient beliefs and behaviour. What is it?

A

There is correlation between beliefs of health care professionals and their patients. Health care professionals do have power of the patient’s perceptions (the force is strong in these ones).

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9
Q

_______ (Surgical/conservative) management achieved far better outcomes for days off, return to work, permanent disability.

A

conservative

For patients > 50 years of age or whose findings suggest systemic disease, plain x-rays and laboratory tests almost completely rule out systemic diseases. Advanced imaging should be reserved for patients considering surgery or where systemic disease is strongly suspected.

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10
Q

What are 2 things that occur as a result of pain education?

A
  1. Increased performance in clinical tests
  2. Decreasing unhelpful pain related beliefs and attitudes
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11
Q

What is the aim of neuroscience education in pain and surgery?

A

to change a patient’s cognition regarding their pain state, which may result in decreased fear, ultimately resulting in confrontation of pain barriers and a resumption of normal activities viewed their surgical experience more favorably and utilized less healthcare in the form of medical tests and treatments

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12
Q

What are the 5 steps that people need to progress through to change behaviour?

A
  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 at present?
    • Taking action
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13
Q

What are 3 things to avoid when trying to change patient behaviour?

A
  1. Telling people what to do
  2. Arguing the point
  3. Scare tactics without offering appropriate hope
  4. Understand your patient’s journey and where they are up to, rather than just giving information.
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14
Q

What are the 3 steps to graded motor imagery?

A
  1. Left/right discrimination
  2. Explicit motor imagery
  3. Mirror therapy
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15
Q

What is left/right discrimination?

A

Research shows people in pain often lose the ability to identify left or right images of their painful body part(s) (i.e when viewing pictures of body parts they are slower and/or less accurate than somebody without pain at determining whether the image is a Left or Right

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16
Q

What is explicit motor imagery?

A

Explicit motor imagery is essentially thining about moving without actually moving. Imagined movements can actually be hard work if you are in pain.

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17
Q

What is mirror therapy?

A

If you put your left hand behind a mirror and right hand in front, you can trick your brain into believing that the reflection of you right hand in the mirror is your left. You are now exercising you left hand in the brain, particularly if you want to start to move your right hand.

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18
Q

What happens in graded motor imagery?

A

Patients image doing movement with the part that is affected –> Intervention that is starting to have effect

  1. Less threatening way (look at images- left or right part)
  2. Imagine doing the movement (eg. plantarflexion/dorsiflexion of ankle without moving ankle)
  3. Using mirror to change perception of brain- approached with caution as it can aggravate pain if not ready
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19
Q

What are 8 characteristics of coping skills?

A
  1. Progressive Relaxation
  2. Activity/Rest Cycles
  3. Pleasant activity scheduling – setting goals to regularly engage in activities that bring you a sense of accomplishment, joy, and pleasure training the body and the nervous system.
  4. Problem-Solving - methods for approaching problematic situations in an organized and structured manner breaking into components.
  5. Challenging negative thinking, use of imagery and distraction techniques – strategies to divert attention from pain and negative mood.
  6. Distraction techniques including use of mental imagery, to divert from focus on pain and negative mood.
  7. Relapse prevention – learning to prevent lapses in effective use of coping skills and to get back on track after lapses occur
  8. Goal setting – methods of setting goals that are realistic, specific, and achievable
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20
Q

What are 7 negative patient behaviours, linked to Cognitive disorders?

A
  1. All-or-nothing thinking
  2. Disqualifying the positive
  3. The fortuneteller error
  4. Magnification (Catastrophising) or minimisation
  5. Emotional reasoning
  6. Should statements
  7. Labelling and mislabelling
21
Q

What is all-or-nothing thinking?

A

If your performance falls short of perfect, you see your self as a total failure

22
Q

What is disqualifying the positive behaviour?

A

You reject positive experiences by insisting they “don’t count” for some reason or other

23
Q

What is fortuneteller error?

A

you can anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact

24
Q

What is magnification (Catastrophising) or minimisation behaviour?

A

You exaggerate the importance of things (such as your goof-up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or other fellow’s imperfections)

25
Q

What is emotional reasoning behaviour?

A

You assume that your negative emotions necessarily reflect the way things really are: “I feel it, therefore it must be true.”

26
Q

What are should statements behaviour?

A

You try to motivate yourself with should and shouldn’t, as if you had to be whipped and punished before you could be expected to do anything.

27
Q

What are labelling and mislabelling behaviour?

A

Instead of describing your error, you attach a negative label to yourself. “I’m a loser.

28
Q

How to shift a boom-bust cycle of activity to a self-paced rehabilitation?

A
29
Q

What did the pain coping skills training (CBT exercises) show?

A

Good benefits from both exercise and cognitive behavioural therapy but done together for best results

30
Q

What are 3 ways that therapists can analyse movement coordination in specific exercises for neuromuscular control?

A
  1. Functional tasks e.g. posture at computer, gait pattern, throwing strategy
  2. Specific tasks e.g. forward flexion of the spine, single leg squat
  3. Individual Muscle length, strength and control with contract/relax
31
Q

In specific exercises for neuromuscular control, an individualised programme is developed at the level of _____ muscles, specific tasks or functional tasks. To retrain awareness of _____, _____ and _____ in postural and movement, to reduce _____ and improve _______.

A

individual; position; contraction; relaxation; sensitivity; efficiency

32
Q

How is a graded activity/exercise progression developed? What are 3 things that it targets?

A
  1. Nervous system: sensitised to perceive threat and pain even with loads that are safe for the tissues
  2. Body: de-conditioned e.g. poor cardiovascular fitness, strength, flexibility and endurance.
  3. Mind: poor self efficacy to try activities associated with pain, and high levels of fear/anxiety that movement will cause more injury.
33
Q

What are 3 things that the therapist has to do for a patient’s pain management?

A
  1. Develop exercises progression to achieve goals in daily activities
  2. Self-reward for behavioural change to overcome barriers in a paced way
  3. Reduce hypersensitivity, improves self-efficacy and body conditioning
34
Q

Motor control exercises and graded activity have _______(similar/different) effects for patients with chronic nonspecific low back pain.

A

similar

People with motor control training reduced their stiffness as a result of exercise training.

For back muscles (for pain), both groups whether they did general physical activity or specific training of myslces = reduced fearful stiffening response = more relaxed

35
Q

What are 2 physiological features that are in graded activity?

A
  1. 5 goal-oriented exercises for cardiovasc, strength, ROM, balance… etc
  2. Challenging but achievable with pain (though not flare-up)
36
Q

What are 3 psychological features that are in graded activity?

A
  1. Facilitation of the patient to progressively shape their own psychological barriers, using physical activity.
  2. Reflection on how passive and external pain management approaches affect quality of life.
  3. Develop patient self-efficacy to lead their own behavioural change though planning exercise quotas, pacing and self-reward /reinforcement.
37
Q

What are 2 physiological features that are in motor control?

A
  1. Aims to optimise movement through awareness of posture and muscle activation
  2. Focusing on paraspinal muscles, abdominals, diaphragm and pelvic floor with therapist – patient feedback progressing to patient self-feedback.
38
Q

What are 2 psychological features that are in motor control?

A
  1. Clinician leads patient rehab initially, guiding the patient in what exercises to do and detailing how to do them.
  2. The patient gradually takes responsibility for application of exercises/movement in daily activities.
39
Q

What are the 6 things that people do to learn most effectively?

A
  1. Shaping
  2. Reinforcement
  3. Pacing
  4. Use association effects (reminders)
  5. Overcome fear-avoidance responses through exposure
  6. Thoughts/beliefs/expectations
40
Q

What is shaping and how does it help people learn more effectively and achieve their goals?

A

start at a level that the person can manage, then practice repeatedly, getting closer and closer to the goal behaviour

41
Q

What is reinforcement and how does it help people learn more effectively and achieve their goals?

A

find thoughts and actions that maintain the goal behaviour i.e. feedback about success or reward it. Self, friends, family, work mates and other health professionals may be important sources of reinforcement. External praise may be used initially, but this must transition to the patient learning to selfreward/reinforce their behaviours. Reinforcement is ideally immediate with behaviour

42
Q

What is pacing and how does it help people learn more effectively and achieve their goals?

A

consider dose of exercise (load, reps, duration, rest period between sets etc.), at a level which is not likely to cause a “flare-up” of symptoms, but also not avoiding all symptoms. Progression is an essential part of this the plan for pacing

43
Q

What is use association effects (reminders) and how does it help people learn more effectively and achieve their goals?

A

Link the exercises to the plan/events in daily activities, so that the exercises are a high priority and they are completed.

44
Q

What is overcoming fear-avoidance responses through exposure and how does it help people learn more effectively and achieve their goals?

A

Explanations may be an important part of enabling initial exposure, then use the patient’s successful experience to encourage further exposure

45
Q

What are thoughts/beliefs/expectations and how does it help people learn more effectively and achieve their goals?

A

Use questions to facilitate patient reflection and understanding, what, when, how, but avoid asking why.

46
Q

What are 10 behavioural changes that happen as a result of pain?

A
  1. Avoid pain and movement
  2. Limit lifestyle and activity
  3. Social isolation
  4. Continue aggravating
  5. New injuries associated
  6. Investigations +/- relevant
  7. Interventions +/- relevant
  8. Rest and passive treatment
  9. Decreased coping for other events
  10. Decreased self care and esteem
47
Q

What are 7 thoughts produced that happen as a result of pain?

A
  1. There’s nothing I can do
  2. I won’t survive this
  3. Somebody save me
  4. Why me?
  5. If I ignore it, it won’t be a problem
  6. Pain shows that I’m pushing hard enough
  7. This is a chance to prove I’m tuff enough
48
Q

What are 7 feelings produced that happen as a result of pain?

A
  1. Panic
  2. Anxiety
  3. Hopelessness
  4. Fear/anger
  5. Denial
  6. Curiosity
  7. Foolish bravado
49
Q

What are 7 physiological changes that happen as a result of pain?

A
  1. Increased HR and BP
  2. Increased Adrenaline
  3. Increased muscle tension
  4. Increased stress at joints
  5. Increased fatigue
  6. Decreased physical condition
  7. Depression

PHTY2101 EOS (22 decks)

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