Chronic Pain Flashcards
According to the biomedical model, what does chronic pain mean?
tissues are not healing and damage is ongoing
- not true, pain can occur without tissue pathology and vice versa
- biopsychosocial model takes into account the psychological, social, and physical aspects associated with chronic pain
What are the three options for treating pain?
- Take the foot out of the fire - avoid activity (fear avoidance)
- put out the fire - opiod use and steroid injections
- cut the wire - surgery
What is the difference between acute and chronic pain
Acute - less than 3-6 months; adaptive, transient, protective role - unpleasant experience
Chronic - over 3-6 months; maladaptive, persists, neuroplastic - life changing
what differences do you see centrally in a chronic pain pt compared to a healthy individual
- fewer areas of the brain “light up” in brain scan
- some areas of the brain are “on” 24/7
- greater atrophy of gray matter
what differences do you see peripherally in a chronic pain pt compared to a healthy individual
hyperalgesia and allodynia are present
What education modifications for patients have been suggested under the biopsychosocial model for chronic pain?
- No sign of serious disease or suggestion of permanent damage
- The spine is strong and pain does not mean your back has serious damage
- encourages positive attitudes and coping
- Numerous treatments are available, but relief depends on your effort
- concentrates on activity to restore normal function
- focuses on moving pt out of the passive role and into active restoration
What role does cognition play with pain?
patients who are more fearful will have worse chronic pain
- the fear of pain is worse than pain itself
- PTs need to identify what patients are afraid of in order to treat
16 item questionnaire designed to quantify fear and avoidance believes for LBP patients; higher scores indicate higher disability and work loss
FABQ
What are the simple universal questions to ask chronic pain patients?
- What are you afraid of?
- Are you afraid the pain will get worse?
- Are you afraid therapy will increase your pain?
What are the 4 treatments that have been successful in treating chronic LBP pts?
- Cognitive Behavioral therapy
- Graded activity
- Aerobic exercises
- Therapeutic neuroscience education
Goal is to replace maladaptive pt coping skills, cognitions, emotions and behaviors with more adaptive ones; misses exercise component; poor medical reimbursement; low pt compliance
cognitive behavioral therapy
operant conditioning - reward well behaviors, ignore pain behaviors; exercise and physical activity - incompatible with pain behavior; stimulation of exercise behavior - lead to a decr. in competing pain behavior
graded activity protocol
- 16 sessions: 1 hr sessions 2x per week
- warm up, core stabilization, LE strengthening, ADL or work stimulation activities, aerobic conditioning
- 1st 3 sessions = done to individual limits of pain; average amount of exercises done baseline value
- PT and pt sit down, agree on goal and set timeline
- no passive modality used; point of protocol is to give pt control and empower pt to control life while PT encourages pt they are not hurting themselves even though they have pain
True or false: Injury always results in pain
False:
- you can be asymptomatic with tissue injury!
- pain depends on the amount of fear we have with that injury
True or false: nerves have to connect to a body part to feel pain
False:
- think about phantom limb pain
- individuals who have been in pain for a long time, the area on the somatosensory cortex becomes less distinct; results in increased pain perception
- “disruption of laterality”
True or False: in chronic pain, the CNS becomes more sensitive to danger messages from tissues
True:
- Central sensitization
What are the 3 pieces of evidence that shows central sensitization occurring?
- Death of interneurons - With persistent firing of C fibers, interneurons may die, due to high levels of amino acids; this will decrease ability to modulate nociception
- AP wind up - repeated stimulation of C fiber can elicit a progressive increase in the number of APs generated by motor neurons and interneurons
- reduction in endogenous chemicals that provide descending modulation
How does peripheral sensitization occur?
- making more ion channels
- changing the distribution of ion channels
- making ion channels stay open longer
- occur in response to myelin damage; strengthen synapse of peripheral nerves
What type of environment will cause a higher chance of chronic pain occurring?
High stress environment
- traumatic injury
- unpleasant jobs
What is the new definition of pain according to Moseley?
Pain is produced by the brain after a person’s neural signature has been activated and concluded the body is in danger and action is required
Process to educate pts about their pain; educates on pain neurophysiology and results in decr. of chronic pain; talks about nociception pathways, neurons, synapses, APs, spinal inhibition and facility, central sensitization, and neuroplasticity
Therapeutic neuroscience education
- average of 2.5-4 hours of education
- billed under NM reed
- suggested to be taught while performing there ex or manual therapy
How should you teach your patients about nerves?
- have over 400 individual nerves that travel throughout your body, about 45 miles
- nerves cominciate stress, movement, temp
- teach about AP reaching threshold
- lights go on, then dim until off until they are needed again
How does persistent pain relate to nerve sensitivity
for every 1 in 4 people, the threshold is lower bc the nerve is more sensitive
- family issues, fear, different medical opinions, etc, increase sensitivity
How can pts calm down nerves?
teach pts aerobic exercises will increase blood flow and help the brain produce happy chemicals
What non-traditional stimuli can cause nerves to become extra sensitive?
- temp
- stress
- movement
- immunity
- blood flow
- pain sensitivity can change every 2-3 days; you can direct brain to calm down over excitement
