Chpt. 1: *Pain and inflammation Flashcards
What are modalities?
A therapeutic method or agent, such as surgery, chemotherapy, or electrotherapy, that involves the physical treatment of a disorder
Can your hands be a modality?
yes
What are the 3 stages of Inflammation, and for what stages are modalities mainly used?
Stage 1=Acute
Stage2=Subacute Proliferation
Stage 3= Chronic Remodelling
Mainly stage 1+2
Describe each of the 3 stages of inflammation? (ex. duration)
1= 0-72 hrs, PRICE,ROM, Isometrics 2= 72hrs to 3-6 weeks, Isotonic (f.w. + therband) 3= up to 1 year, sport/workspace, isotonics (CKC)
**What are some common modalities in PT?
- heat/cold
- electrotherapy
- ultrasound
- laser
Why are electrical modalities, or modalities in general, used less commonly now?
Over reliance of the use of modalities
Guideline #3?
TENS?
What are 4 non-direct activities related to modlities?
- Cleaning and care
- Storage
- Reporting of problems
- Some maintenance
**What are some basic Cardiovascular Red Flag Signs ?
- pain radiating down upp. extremity
- Jaw pain
- Shoulder girdle pain
- Night Pain (weight loss + night sweats)
What happens to a systemic level when there is pain?
ANS (autonomic neurosystem) responds
What happens on a local level when there is pain?
- spasm
- edema
- release of pain chemicals
?**Name 4 chemicals that cause pain in the body?
- potassium,
- serotonin,
- histamine,
- substance P
**What are the 3 types of Pain?
Acute
Chronic
Referred pain
*What is Acute Pain?
- short lived
- to do with; muscles strains
- tendinitis
- contusions
- surgery
- ligament injuries
*What is Chronic Pain?
- persists after 3months after noxious stimuli has been removed
- cause is unknown/uncorrectable
- medical treatments ineffective
What is referred pain?
Pain that is felt at a site distant from the location of injury or disease
What are some causes for Chronic Pain? (5)
- Mechanical (nerve entrapment)
2.Chemical
3.Regeneration (nerve irritation)
4, Reflexes (persistent motor reflexes after acute inflammation) - Inhibitory failure (failure of CNS to release “ENDOGENOUS OPIATES”
What is the “cycle of pain”?
–> often psychological
- pain
- spasm
- lack of use
**What are some places for Organs that have a referred pain?
- Heart–>arm
- Gallbladder –>Neck
- Bladder
- Kidneys
- Lungs
What are the 2 Pain Scales?
- Visual analogue scale (VAS)
2. McGill Pain Questionnaire (MPQ)
What is the VAS?
- It is quite reliable*
- 10 cm line;
- R. S. worst pain
- L. S. no pain
What is the MPQ ?
Contains body diagrams and word descriptors
3 catagories: sensory, affective, evaluative
What is the point of Pain scales?
- Quality of Pain
- Pain intensity
- Psychological aspects
What are some other Pain Scales other than VAS and MPQ? (4)
- The Oswestry Low Back Disability Questionnaire
- Waddell Disability Index
- Disability Questionnaire
- Arthritis Impact Measurement Scales
Is pain usually descending or ascending?
Ascending
What are Nociceptors?
Found where?
Signal actual or potential tissure damage
- skin
- viscera
- soft tissue
- bone
- muscle
*what is A delta?
-biggest; sharp and pricking sensation – well localized and of sharp sensation (acute)
*What are C fibers?
-smallest; produce a longer lasting burning sensation (chronic)
*?What are the 3 types of fibers, and what is their function?
(Alpha=motor
Beta=Sensory
Delta=Pain)
What cell bodies are found in Dorsal Root Ganglia?
A-delta
C-fibers
A-beta
What is the function of the Dorsal Horn?
What are it’s cell bodies?
-RELAY area; signals sent relayed to THALAMUS
A-delta
C-fibers
A-beta
What are relays for?
to speed up transfers and sinals
- What is the Gate Control Theory of Pain?
* pg. 25=picture
- A and C fibers transmit pain signals to the Substantia Gelatinosa in the Dorsal Horn (grey matter)
- here they’re mixed with other non-nociceptive input
- signals (pain or non pain) are then sent via T cells to thalamus
What are the 5 components of the Gate Control Theory of Pain ?
A-delta C-fibers A-beta Substantia Gelatinosa T cells
What affects the intensity and type of ascending signal by T-cells?
ex.?
Our bodies natural pain killers
ex. endorphins, dopamine, serotonin (“happy hormone” + pain killer) enkephalins,
What are the different areas/steps/relays with pain: (11)
- Stimuli
- Impulse Transmission
- Sensory Fibers
- Cord junctions
- Dorsal Horn
- Synapse
- Calcium release
- Synaptic Cleft
- Post Synaptic Cell
- Nociceptive Pain
- Pain perception
What brings the patient usually into treatment/assessments ?
Pain
*What are modalities and/or pain killers directed towards?
Breaking the pain-spasm cycle
What are 2 types of modalities to break the Pain cycle?
- Thermal modalities
- Electrical modalities
What are 3 stages that all soft tissue injuries must progress through to effectively heal?
- Inflammation
- Proliferative
- Remodelling
What are the three phases of the PROLIVERATIVE Phase (3-20 DAYS)?
Phase 1=granulation – fibroblasts and epithelial cells
Phase 2=wound contraction – myofibroblasts – “pull the wound together”
Phase 3=collagen production.
*What are (4) reasons for delayed wound healing?
- compromised immunity (ex. AIDS)
- certain meds (ex. NSAID/Steroids/Anti-rejection drugs
- radiation/chemotherapy
- aging
List 3 ways PT can augment (speed up) open wound healing ?
- (EMS) Electrical stim
- CPM machines to assist with scar formation
- (PUVA) UV light
**What are (5) goals of treatment for Therapeutic Massage?
- Restore optimal function when possible
- Prevent further injury
- Maintain or increase tissue/fluid interchange
- Maintain or increase joint mobility
- Maintain or increase muscle tone (or decrease if needed) and flexibility
**What are (11) Contraindications for Massages?
- Undiagnosed lump
- Contagious skin condition
- Acute infection
- Recent wound
- Burn
- Open lesion
- Contagious disease
- Fever
- Cancer
- Hyperesthesia
- Rheumatoid arthritis
What are the 3 types of Massages done in class?
Pinswa=
- Efflurage
- Petrissage
- Tapotment
What are the 2 types of Massages ?
Relaxation Massage
Therapeutic Massage
After a Therapeutic Physical Intervention such as a massage, ___ or ____ and ____ of the skin occurs.
Redness
Blanching
Mottling of the skin
What is the test called where nail bed should refill in 3 sec. after pressure?
Circulatory Irreg. capillary refill test
When HEAT is applied what will be caused?
LOCAL VASODILATION (redness)
When COLD is applied what will be caused?
a cooling effect followed by REFLEX VASODILATION
What are 6 Pain Assessments? Why?
- VAS
- Pain Ratings
- Questionnaires
- Anatomic Pain Drawings
- Facial Expression of Pain,
Subjective Data
What is Therapeutic Massage defined as ?
A series of manipulations of the body done with scientific knowledge of the structure and function of the body in a rational, skillful manner for therapeutic results.
What are some non-direct activities, but still part of a TA’s responsibility, related to modalities ?
-Cleaning and care
-Storage
-Reporting of problems
Some maintenance
What are Basic Principles of Massage:
General–> Specific–>General (start and finish large part of body )
- Superficial–> Deep–>Superficial
- Proximal–>Distal–>Proximal
- Periphery to center
What are some conditions treated with massage?
Musculoskeletal conditions:
- strains
- postural concerns
- inflexibility
- post exercise (soreness)
Stress conditions: headaches,
- insomnia
- chronic pain
