B2 L29 Putting it together for pain

Question 1

It is possible to have pain and not know about it. True or false

Answer 1

False

Question 2

When part of your body is injured, special pain receptors convey the pain message to your brain. True or false

Answer 2

False

Question 3

Pain only occurs when you are injured or at risk of being injured. True or false

Answer 3

False

Question 4

When you are injured, special receptors convey the danger message to your spinal cord. True or false

Answer 4

True

Question 5

Nerves adapt by increasing their resting level of excitement. True or false

Answer 5

True

Question 6

The body tells the brain when it is in pain

Answer 6

False

Question 7

Nerves adapt by making ion channels stay open longer. True or false

Answer 7

True

Question 8

Descending neurons are always inhibitory. True or false

Answer 8

False (while most are, not all)

Question 9

Pain occurs whenever you are injured. True or false.

Answer 9

False

Question 10

When you injure yourself, the environment that you are in will not affect the amount of pain you experience, as long as the injury is exactly the same. True or false

Answer 10

False

Question 11

The brain decides when you will experience pain. True or false

Answer 11

True

Question 12

What do employers look for? What are 4 “soft skills” and why do they matter?

Answer 12

1. To start earning patient trust from the first eye contact and handshake.
2. Understanding the patient and their experience.
3. The ability to connect and communicate.
4. They employ attitude and train skill (willingness to learn)

These characteristics will maintain the relevance and effectiveness of physiotherapy for generations to come. Keeping your practice personal is one of the keys to keeping your career satisfying.

Question 13

What are the 6 features in Bloom’s taxonomy of learning?

Answer 13

1. Remembering
2. Understanding
3. Applying
4. Analysing
5. Evaluating
6. Creating

Question 14

As physios, we have the responsibility to treat patients but also be aware and treat with ______

Answer 14

suspicion

Question 15

Is it a biological or neuropathic driver?

Answer 15

Biological

Question 16

Periperal sensitisation?

Answer 16

Yes (eg. phenotypic switch)

Question 17

Central sensitisation?

Answer 17

Yes (less than peripheral sensitisation) Some pain at rest while not a lot of input going in peripherally

Question 18

Psychological/social drivers?

Answer 18

Yes- such a high need to continue to connect with - Too much injury and not enough pain (ignoring their body) - Central factors (to get ready for the games)- giving false “hope” - often have barriers due to fear of pain

Question 19

Behavioural change needed?

Answer 19

What is driving the need to participate in touch football, that their body is less important

Question 20

Biological or neuropathic drivers?

Answer 20

neuropathic- pins and needles/numbness and dermatome (S1-L4- possible lesion); nociplastic

Question 21

Peripheral sensitisation?

Answer 21

Yes- while there is no frank swelling or acute injury to peripheries, processes been gradually occurring (with minor trauma), sedentary lifestyle (tissues (eg. muscles) become more easily damaged/challenged by simple daily activities/vulnerable)- phenotypic switch, allodynia (light touch), ectopic firing, neurogenic inflammation (if had swelling)

Question 22

Central sensitisation?

Answer 22

persistent, latent pain, amplification, wind up (small input in peripheries that builds once reaches spinal cord), cortical remapping, no great motor control awareness of body- so many “fireworks- input” from up from the body

Question 23

Psychological/social drivers?

Answer 23

mainly risk factors (to attribute or reinforce to pain) fear-avoidance Pain during enjoyable activity (eg. cooking) to modulate plasticity- motivate patient, change is worthwhile- to get out of passively dependent

Question 24

Behavioural change needed?

Answer 24

change is worthwhile (see above) - psychological change - pain is not always a measure of activity

Question 25

Biological or neuropathic drivers?

Answer 25

Biological

Question 26

Peripheral sensitisation?

Answer 26

Yes- reoccurring injury, acute inflammation and pain, peripheral sensitisation.

Question 27

Central sensitisation?

Answer 27

Yes- persistence of pain with low load due to recurrent injury

Question 28

Psychological/social drivers?

Answer 28

need support, determine how much tissue can tolerate without flaring up NS

Question 29

Behavioural change needed?

Answer 29

support, graded exposure (mix between protection biologically and mindset psychologically

Question 30

“I treat with what works vs theoretical concept.” What is the problem with this?

Answer 30

• Need to continue to ask question- do not always accept theories
• This risks biases and seeks to justify ignoring best evidence/guidelines

Question 31

“For a patient with a myocardial infarct, I treat the cardiac problem and not the pain.”. What is the problem with this statement?

Answer 31

• What about when the stimulus does not explain the pain or disability?
• Experimental models of pain in research constantly depend on the fact that pain can occur without any injury.
• Analgesics use depends on the fact that the pain being treated was a warning or danger signal with little or no actual threat of injury

Good biopsychosocial complex includes biomedical problem- treats body and mental status as well

Question 32

“A biomedical model of pain treats the mechanism of injury or pathophysiology of disease. Psychology of pain is considered only if pain persists or becomes chronic.” What is the problem with this statement?

Answer 32

• Human physiology, behaviour, thoughts and feelings exist in the environmental context and how it is interpreted.
• Unhealthy to blame patient and psychological behaviour if treatment is unsuccessful

Question 33

“Physiotherapy was listed amongst “alternative methods for pain management”, after acupuncture and chiropactic, with the phrase “limited long-term success in systematic reviews?” What is the problem with this statement?

Answer 33

Ignorance regarding outstanding physio research has to be overcome.

Question 34

What are the 3 guidelines about best management of acute low back pain based on the National Health and Medical Research Council?

Answer 34

1. When you have this acute non-specific back pain that you should not receive an x-ray because it is not necessary and it can cause harm
2. Advice to stay active, within the limits of your pain.
3. Returning to your normal activities, including work, as quickly as reasonable, and avoiding bed rest.

Question 35

The psychological impact of seeing an image is much ______ (larger/smaller) than, say, the result of a blood test. What is the impact of seeing an image (MRI) in terms of improvements

Answer 35

Larger

• When only half of the participants with back pain were given their MRI results, those that did not get the results reported better improvements on follow-up than those who received their results.
• Simply getting the results of an MRI scan may be sufficiently alarming that people feel less healthy.

Question 36

_______ is fundamental to human mind e.g. unconscious patient with 3 similar tones then one higher – will elicit a brain activity response with the unexpected pitch

Answer 36

Expectation

Question 37

Traditional view of the brain function with ______ was from _____ to _____. Piecing together info to decode meaning. Newer view is from _____ to ______ of the brain, so that _______ takes precedence.

Answer 37

vision; rear; front; front; back; prediction

Question 38

Afferent input simply provides feedback on ________. The brain aims to minimise its prediction error.

Answer 38

prediction error

Question 39

What are 2 things that a psychedelic experience is determined by?

Answer 39

1. Set: user’s character, expectations and intentions, as well as
2. Setting: social and physical surrounding in which the drug experience takes place.

Question 40

What is “set” in relation to a psychedelic experience?

Answer 40

Set: user’s character, expectations and intentions, as well as

Question 41

What is “setting” in relation to a psychedelic experience?

Answer 41

Setting: social and physical surrounding in which the drug experience takes place.

Question 42

What are 3 components that make up an effect being perceived?

Answer 42

Drug + expectations + social/environment

Question 43

What are 3 components that make up pain being perceived?

Answer 43

Tissue physiology + beliefs/understanding + social/environment

Question 44

What is superaditivity in terms of pain? Give some examples

Answer 44

• Are scans or advice for vulnerable / poor prognosis pathoanatomy superadditive for perceived threat, pain and disability?
• Does an unpleasant task or context add to the perceived physical threat and superadd to pain perception?

Question 45

What is additive suppression in terms of pain? Give example

Answer 45

Does education about an intervention’s clinical evidence and mechanism of effect contribute additive suppression to reduce pain perception?

Question 46

What is sensory dominance in terms of pain?

Answer 46

• Would multisensory input of painfree movement or mobes provide additive suppression or sensori dominance to reduce the perception?
• Does an activity / a physical or social environment that you enjoy / a meaningful goal for ‘success’ provide sensory dominance to reduce pain perception?

Question 47

What are the 3 factors of persistent pain?

Answer 47

1. Stress
2. Neuro
3. Immune