chap 3 Pain tone and motion

Question 1

• “an experience based on a complex interaction of physical and psychological processes.”
• An unpleasant sensory and emotional experience
• Associated with actual or potential tissue damage
• Can be a warning sign
• Most common symptom prompting patients to seek medical attention

Answer 1

pain

Question 2

pain that is Less than 6 months duration

Answer 2

Acute pain

Question 3

pain that Persists beyond the normal time for tissue healing-

Answer 3

chronic

Question 4

The experience of pain in one area when the actual or potential tissue damage is in another area

Answer 4

Referred pain

Question 5

And what technique can we utilize to determine location of pain?

Answer 5

palpation

Question 6

this pain Activates sympathetic nervous system

Answer 6

acute pain

Question 7

Caused by the stimulation of pain receptors by noxious mechanical, chemical or thermal stimuli and associated with ongoing tissue damage

Answer 7

Nocioceptive pain

Question 8

Result of peripheral or CNS dysfunction without ongoing tissue damage

Answer 8

Neuropathic pain

Question 9

Psychological and social factors associated with chronic pain:

Answer 9

Depression
Catastrophizing
Decreased function
Decreased ability to maintain employment
Increased dependence

Question 10

this pain is felt at a location distant from its source.
May be referred from one joint to another
Peripheral nerve to a distal area of innervation
Internal organ to an area of musculoskeletal tissue

Answer 10

Referred Pain

Question 11

It is proposed that pain is referred in one of three (3)ways: what are they

Answer 11

From a nerve to its area of innervation
From one area to another derived from the same dermatome
From one area to another derived from the same embryonic segment

Question 12

specific nerve endings called nociceptors respond to all painful stimuli, and specific nerve types transmit the sensation of pain from these nerve endings to the spinal cord and then within specific tracts, to the brain. What are these fibers called?

Answer 12

• myelinated A-delta fibers

- unmyelinated C fibers

Question 13

Large, myelinated axons that conduct impulses more quickly than A-delta and C fibers
Located in the skin, bones and joints
Normally, transmit sensation related to vibration, stretching of skin and mechanoreception

Answer 13

A-Beta Fibers

Question 14

• Group III afferents
• Transmit more rapidly
• Most sensitive to high intensity mechanical stimulation
• Sensations described as sharp, stabbing, or pricking
• Generally, not blocked by opiates

Answer 14

A-Delta Fibers

Question 15

Sharp, pricking or tingling

Answer 15

Cutaneous pain

Question 16

Dull, heavy or aching

Answer 16

Musculoskeletal pain

Question 17

Aching quality similar to musculoskeltal

Answer 17

Visceral pain

Question 18

Pain Documentation

Answer 18

Remember, when documenting pain, the pain should be QUANTIFIED. Also, the location, quality, severity and timing as well as factors that make it worse or better, the setting in which it occurs and other manifestations should be included.

Question 19

The balance of excitatory and inhibitory inputs

The inhibition of pain by input from the non-nociceptor afferents

Answer 19

Pain Gating

Question 20

Muscle spasm
Ongoing muscle contractions
Contraction muscles may also initiate further nociceptive impuses
Ongoing stimuli can set up a sustaining cycle of pain

Answer 20

Pain-Spasm-Pain Cycle

Question 21

• Neurotransmitter thought to be involved in the transmission of neuropathic and inflammatory pain
• Present in both the central and peripheral nervous systems
• Appears to be involved in the sensitization of pain transmitting neurons and in the development of hyperalgesia
• Release and receptor activation is thought to be a response to tissue injury and stress

Answer 21

Substance P

Question 22

Pain is modulated at the peripheral, spinal cord and cortical levels via opiates

Answer 22

The Endogenous Opioid System

Question 23

Analgesic and anti-inflammatory
Ex: Aspirin
Associated with gastrointestinal irritation and bleeding with long term use

Answer 23

NSAIDS

Question 24

Effective at treating mild to moderately severe pain; however, has not significant anti-inflammatory activity
Prolonged use can cause liver damage
Skin rashes are also an occasional side effect

Answer 24

Acetaminophen

Question 25

Drugs that contain opium
EX: Morphine, codeine, oxycodone
Used to control even the most severe acute pain
Side effects include: nausea, vomiting, sedation, suppression of cough, gastrointestinal mobility, respiration and propensity to cause physical dependence and depression with long term use

Answer 25

Opioids

Question 26

Remember, per the APTA, the utilization of only physical agents does not constitute physical therapy!

Answer 26

fyi

Question 27

objectives for chap 3

Answer 27

Discuss various pain theories and their utilization in physical therapy patient care techniques (#3)
Define acute, chronic and referred pain (#4)
Identify effects of physical agents on pain relief and functional activities (#5)