Concepts of Pain Flashcards
Definition of Pain
Unpleasant sensory and emotional experience associated with actual or potential tissue damage or describe in terms of such damage
What are the 6 Dimensions of “The Pain Experience”?
Nociception
Pain perception
Attitudes and beliefs
Psychological distress (suffering)
Pain behavior (disability)
Environment
Nociception
Stimuli that leads to nociceptive input. These stimuli act on peripheral nerve receptors
Pinch skin, pain on skin, harder pinch = more pain
Pain perception
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
Psychological Suffering
Affective response
Attitudes, emotions, moods in response to pain
Also occurs with : grief, stress, anxiety
Pain behavior (disability)
The way an individual acts which suggests presence of pain
Fear avoidance
Avoid activities do to anticipation of pain
Environment
Influence of health care providers, family and friends and other that the person interacts with
Who do you think “experienced” more pain?
Nail in head or paper cut?
A: Paper cut. Didn’t know nail was in head.
How is pain perceived?
Input (tissues) -> processing (spinal cord to brain) -> output (perception of pain)
Premotor/motor cortex
Organize and prepare movements
Cingulate cortex
Concentration, focusing
Prefrontal cortex
Problem Solving, memory
Amygdala
Fear, fear conditioning, addiction
Sensory cortex
Sensory discrimination
Hypothalamus/Thalamus
Stress response, autonomic recognition, fear conditioning
Spinal Cord
Gating from the periphery
Why is the output of pain odd?
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)
Local Response - What type of pain?
Peripheral Sensitization
Due to neurophysiological changes in the mechanoreceptors, increase sensitization to local stimulus
Central Response
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
Nociceptive Pain
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
Peripheral Neurophatic
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
Central (or peripheral) sensitization
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
How do we screen?
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)
Why do we classify pain?
Changes our treatment plan
