Chronic Pian management Flashcards
how to safeguard against future failed efforts
- identify yellow flags
- maladaptive believes/expectations/behaviours
- presence of major life stressor
- look for signs of self efficacy
what are maladaptive beliefs and pain behaviours
-reflexive behaviours that are not the result of intentional make
(continued avoidance of mvmt, disengagement, catastrophizing, fear avoidance, anticipation of pain)
what in the most important determinant of disability
Self efficacy
examples of classification systems in management (3)
- stages of healing
- Pain mechanisms
- injury mechanisms
features of inflammatory stage of healing
0-7d
- transient vasoconstriction leads to microvascular dilation
- pain w mvmt, evidence of gaurding
- night pain
what to do w pt in inflammatory stage
- educate, reassure, protect
- unloaded movement with pain free available ranges of motion
what to do w pt in proliferative phase
- unloaded movement, working towards full ROM within 4-6w
- Introduce controlled loading within pain free postures and jt pos.
What to do w the patient in the repair and remodelling stage of healing
- Use dif loading stats to continually remodel connective tissue (end range loading, EC)
- time under tension to build endurance and challenge greater ROM in combo w multi jt movements (usually lack of loading when not progressing)
what is nociceptive inflammatory pain
- typically localized, intermittent or consistent-described as swollen, full, throbbing
- earliest stages of tissue healing OR too much too soon in later stages, increased pain in morning/evening
What is nociceptive ishemic and when does it happen
-occurs later in healing response (>12W)
- insufficient vascularization and oxidation of tissues
- worse as the day progresses or activity dependent
neurogenic/neuropathic pain mechanisms
localized (receptor field)
-less predictable 24hr period, often worse at night
what are affective pain mechanisms
Involves central pathways related to negative emotions, perceptions and behaviours
What are central sensitization pain mechanisms
Altered cognition and interpretation of nociceptive signals occurring in the CNS
-persistence nociceptive input can induce CNS changes
What are motor/autonomic pain mechanisms and Ex,
- facilitated inflammatory mechaniss, autonomic/vasomotor dysfunctions, neuroplastic/cortical changes
- widespread, non anatomical distribution w inconsistent 24hr behaviour
ex- CRPS
What is derangement syndromes and how to TX
-disturbance of normal resting pos of jt surfaces,resulting in pain
- avoid mvmt direction that exacerbates pain and adress faulty mvmts patterns
- Utalize mvmt strats that abolish/reduce pain
What are dysfunction syndromes and how to tx
-deformation of struccturally impaired msk tissues (end range/restricted mvmt)
- tissue deconditioning/fatigue almost always a factor
- mobailzing exercises in the direction of dysfunction or direction of reproduction of pain (restore ROM)
Tissue fatigue syndrom and how to tx
- High volume of repativi physical stress to tissues over prolonged duration (slow + progressive onset)
- Reduce cumulative tissue load with active and passive strats, identify contributing environmental factors
What is postural stress syndrome and how to tx
- pain arrives w static positioning and abates w moveemnt
- pt education on mechanism behind cumulative postural strain, pacing, general fitness/conditioning
5w of massage for fibromyalgia did what
recuded anxiety/depression
HVLA effects
- increase pain thresholds and decrease motor neuron excitability measured by the H reflex
- SMT can decrease mm spindle activity, reduce motor neuron excitability and reduce EMG
-not better than other tx tho
how does nerve sliding initiate tension (3)
- 1st 1/3 of mvmt takes up slack
- 2nd 1/3 of mvmt is where sliding occurs
- 3rd 1/3 of mvmt is where tension develops
General pa guidlines
- No correct activity excists
- pt guided, shorter duration, low intensity
- adequate recovery periods
- can have discomfort day but not a flared day following
psychological benefits of exercise
BDNF enhance the survival and differentiation of neurons and stim neurogenesis
-improves the quality of sleep, counteracts the mental decline w age, effectove at tx depression + anxiety
running vs weight training for depression
both similar; no sig difference
best exercise for OA
stregening/full body/aerobic probably best
effectiveness of ex for fibromyalgia
sig benefits
- most prefered arobic compared to strength
- 8w of aerobic was superior
- pool therapy was good too
tx for acute/chronic LBP
acute- reassurence, adviem self care strats
chronic- education, self management, stay active, sup exercise, multimodal rehab
Exercise choses for chronic lowbackpain
exercise should mimic most vulnerable mvmts
incomprlete vs complete tears strain %
incomplete start at >6%
Complete occur at 8-10%
-research suggests that tendinosis may be the result of chronic underloading and not overloading
traffic light system for exercise prescription
Green- pain is no worse than baseline or pain improves and resolves after 6hr
Yellow- pain persists but no worse than during activity, takes >6hrs to resolve
Red- Pain worsens during exercise and it stops you from performing the activity any longer
