Concepts of Pain

Question 1

Definition of Pain

Answer 1

Unpleasant sensory and emotional experience associated with actual or potential tissue damage or describe in terms of such damage

Question 2

What are the 6 Dimensions of “The Pain Experience”?

Answer 2

Nociception
Pain perception
Attitudes and beliefs
Psychological distress (suffering)
Pain behavior (disability)
Environment

Question 3

Nociception

Answer 3

Stimuli that leads to nociceptive input. These stimuli act on peripheral nerve receptors

Pinch skin, pain on skin, harder pinch = more pain

Question 4

Pain perception

Answer 4

Perceived peripherally

Perceived centrally

May be perceived in absence of tissue damage/pathology due to sensitization to the central and peripheral nervous system

Chronic Pain

Question 5

Psychological Suffering

Answer 5

Affective response

Attitudes, emotions, moods in response to pain

Also occurs with : grief, stress, anxiety

Question 6

Pain behavior (disability)

Answer 6

The way an individual acts which suggests presence of pain

Fear avoidance

Avoid activities do to anticipation of pain

Question 7

Environment

Answer 7

Influence of health care providers, family and friends and other that the person interacts with

Question 8

Who do you think “experienced” more pain?

Nail in head or paper cut?

Answer 8

A: Paper cut. Didn’t know nail was in head.

Question 9

How is pain perceived?

Answer 9

Input (tissues) -> processing (spinal cord to brain) -> output (perception of pain)

Question 10

Premotor/motor cortex

Answer 10

Organize and prepare movements

Question 11

Cingulate cortex

Answer 11

Concentration, focusing

Question 12

Prefrontal cortex

Answer 12

Problem Solving, memory

Question 13

Amygdala

Answer 13

Fear, fear conditioning, addiction

Question 14

Sensory cortex

Answer 14

Sensory discrimination

Question 15

Hypothalamus/Thalamus

Answer 15

Stress response, autonomic recognition, fear conditioning

Question 16

Spinal Cord

Answer 16

Gating from the periphery

Question 17

Why is the output of pain odd?

Answer 17

Pain does not only happen it can come off as other systems

Pain
Motor Control
Autonomic Function
Endocrine Function
Immune Function
Etc.

Associate bad experiences with pain at thought, touch, smell (ex: food posioning)

Question 18

Local Response - What type of pain?

Answer 18

Peripheral Sensitization

Due to neurophysiological changes in the mechanoreceptors, increase sensitization to local stimulus

Question 19

Central Response

Answer 19

Central sensitization

Altered processing of pain in the spinal and supraspinal centers

Leads to secondary hyperalgesia
Experience pain in lateral epicondyle now to the wrist or shoulder
Spreading of symptoms

Question 20

Nociceptive Pain

Answer 20

Chemical, Mechanical or thermal pain

Pain is proportionate

Describe pain as intermittent sharp, dull ache at rest, no night pain

No shooting, burning or electric type sensation

Easily able to identify aggravating and alleviating factors

May have REFFERED PAIN

Each joint has common referral pattern

Ex: Myofascial Trigger Points

Question 21

Peripheral Neurophatic

Answer 21

Radicular or radiating pain

Described as shooting, burning or electric type

May have numbness and tingling

History of nerve pathology or compromise

Commonly desribe symptosm in a cutaneous or dermatomal distribution

Question 22

Central (or peripheral) sensitization

Answer 22

Chronic/Persistant Pain

Disporportionate pain to the mechanism or nature of their injury

No pattern

Difficulty describing aggrating or alleviating factors (everything hurts and/or nothing helps)

Exam reveals broad diffuse tenderness

Lower threshold to activity or pressure prior to onset of pain

May be associate wirh other psychological issues or personal beliefs

Question 23

How do we screen?

Answer 23

Numeric Pain Scale (Rate 0-10)
Ransford Pain Diagram (Figure and draw)
Central Sensitization Inventory (Response to statement)
Fear Avoidance Belief (pain related to beliefs; kinesiophobia)
Pain Catastrophizing (lack of confidence to get better)

Question 24

Why do we classify pain?

Answer 24

Changes our treatment plan