Cervicothoracic Spine II Flashcards
Sensitization is an underlying mechanism with __________ P!
nociplastic
With nociplastic pain, there is increased _________ and __________ by central structures
sensitivity; misinterpretation
With nociplastic pain, there is increased _________ of segmental ______ horn neurons
excitability; dorsal
With ____________ P! there is no loss of descending anti-nociceptive mechanisms
Nociplastic
With loss of descending anti-nociceptive mechanisms (noicplastic pain)
there is less __________ opiates released
less ______ control
endogenous; P!
With nociplastic P! there are ____-fibers that transmit ______ and travel at least 2 spinal segments sup. and inf..
C; Pain
With nociplastic P! which part of the brain is “sumdged”?
homunculus
What are 3 conditions that contribute to nociplastic P!?
- Neck P!
- Migraine
- Shoulder P!
- Lateral elbow P!
- Low back P!
- Age-related joint changes
- Persistent fatigue syndrome
- Fibromyalgia
What is the condition for these symptoms?
- ≥ 3 months of P!
- Regional or spreading symptoms
- P! that cannot be explained by nociceptive or neuropathic pathways
- P! hypersensitivity or allodynia (non-painful stimuli causing P!_)
- Sensitivity to sound, light, and or odor
- Sleep disturbances
- Fatigue
- Cognitive problems
Nociplastic p!
What is the most accepted manual therapy for nociplastic pain?
JM
Doing JM on ___________ p! patients help stimulate decreasing inhibitory P! mechanisms, which creates more ________
Nociplastic; endorphins
JM for nociplastic p! patients helps to reduce ….
dorsal horn excitability and inflammatory mediators
What is the MET prescription for Nociplastic P! patients?
low to moderate-intensity global and aerobic resistance activities
2-3x/wk
30-90 mins per session
at least 7 weeks
What are the purposes of MET for patients with nociplastic P!?
- Endogenous/opiate analgesia
- Helps pt. interpret p! and motion as non-threatening
- Reorganizes Homunculus
What should you educate your pt. on for nociplastic pain?
Explain increased sensitivity and misinterpretation to reduce stress/anxiety of misperceived tissue injury
What do you want to transition to overall with nociplastic pain?
adaptive P! coping
What is the prognosis for nociplastic pain patients?
- Varying degrees of improvement
- Longer recovery
- Likely not full resolution of symptoms
What is the percentage of people who will experience Neck pain?
70%
What is the percentage of people who will develop persistent neck P!?
33-44%
Neck P! is more prevalent with what biological sex and age?
older biological females
Risk factors for Neck P!
Biological _________
Hx of _______ P!
> ______ yrs. of age
______P! (UBP or LBP)
females
neck
40
LBP
Neck P! is MOST often…
A. identified
B. unidentified
B
Neck P! is often misdiagnosed as ________ or _______
MND; N. root compromise
Full Neck EXT is ____-_____
50-70
Function Neck rotation for driving is ____-_____ and full ROM is ____-____
60-70
70-90
With Neck P! there will be impaired ________ mechanics
scapular
_______ often fails to identify neck P! symptoms
imaging
With neck pain…
____-______ % w/bulging herniated discs
____% annular tears
_____% spinal cord compression
50-73
94
13
With neck pain, _______ _____ lacks strong diagnostic accuracy measures necessary for clinical decision-making
clinical tests
Neck P! with movement coordination impairments (whiplash
associated disorders) is associated with ____________
hypermobility
Neck P! with mobility deficits is ____________
hypomobility
With neck pain, cervical JM modulate _______ function
This also increases ________ muscle recruitments
muscle; deep
With MET for neck pain, there is ______ evidence
strong
MET for neck pain should consist of
___-_____ minute sessions
__-__x/wk
__-___ wks
30-60
2-3
7-12
With neck pain, it should include exercise for…________, _______, _______, and _______ regions
cervical, thoracic, scapular, and shoulder
What are the 3 purposes of MET for neck pain?
- stabilization
- endurance
- strength
Local and global muscle training should consist of ____ load endurance for _____ weeks
low; 6
With local and global muscle training, exercise is effective in _________
isolation
What is an example of isotonic and isometric local/global muscle training?
forward nodding
What should you tell your patient to do before beginning any exercises?
SIT TALL!
How to keep up with exercises for neck P?
___x a week for over a year
___-___ visits
___x week for _____ wks.
3
8-12
2x/ 6 wks.
With neck P! ________ is NOT beneficial in isolation
this should be combined with MET
stretching
What is the current evidence regarding modalities for Neck Pain?
lacking, limited, or conflicting and NOT recommended for Neck P!
What are two main things you should you educate your pt. on for neck P?
early movement w/o provocation
reassure them of a good prognosis and full recovery in MOST cases
Prognosis regarding neck P!
_____ trauma: quicker recovery
______ trauma: longer recovery
acute; worse
With ______ ______: there are major limitations of pharmaceuticals are the lack of replication of the findings indicating inconsistency of results
MD Rx
With epidural injection, it occurs around the ….
dura of the spinal n.
Oral medication has _______ results and _____ benefits
mixed; unclear
