Definition Flashcards
what is the difference between pain tolerance and pain treshold
tolerence: already in pain zone and how munch you’re welling to stay in this pain
threshold: point where pain is first felt
definition of pain
an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
T/F pain cannot be inferred solely from activity in sensory neuron
T
what is nociception
neural process of encoding noxious stimulus
does nociception = pain
no
pain is an _ of the brain and nociception is an _ to the brain
ouput, input
what is the biopsychosocial model
iopsychosocial model essentially incorporates the biomedical model (by taking into account biological factors)… But is even more comprehensive and includes other factors (psychological, social).
what are the composent of the biopsychosial model
the causation (multi-factorial) and the humanistic (person-centered)
what is pain modulation
turning the volume (nociception) up or down
explain how nociception is modulate in PNS
Nociceptor = a type
of sensory neuron (Aδ fibers, C fibers)
explain how nociception is modulate in CNS
- Spinal cord
(spinothalamic tract) - Thalamus
(relay station) - Somatosensory
cortex (homunculus)
what are the 4 carasteristic of peripheral sensitization
Increased responsiveness of nociceptors to stimulation of their receptive fields
Increased size of nociceptors’ receptive fields
Reduced threshold of nociceptors to stimulation of their receptive fields
Activation of silent nociceptors
(approximately 1/3 of nociceptors innervating the joint, skin, or viscera are silent)
what are the 4 systems involved with stress responses
HPA axis
ANS
endocrine system
CV system
what are the 4 carateristic of central sensitization
Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input
Increased size of receptive fields for nociceptive spinal dorsal horn neurons (include entire limb or even contralateral/bilateral limb)
Reduced threshold of nociceptive spinal dorsal horn neurons to stimulation of their receptive fields
Temporal summation of pain (“wind-up” of nociceptive dorsal horn neurons) = progressively increasing pain to the same stimulus administered repetitively or over a long duration.
chronic pain is a _ condition
neurological condition
what is hypoalgesia
Diminished pain in response to a normally painful stimulus.
what is hyperalgesia
Increased pain from a stimulus that normally provokes pain
what is allodynia
Pain due to a stimulus that does NOT normally provoke pain.
what is temporal summation of pain
refers to the “progressively increasing activity of dorsal horn neurons” in response to repetitive or sustained noxious stimuli.
what is a important clue for central sensitization
temporal summation of pain
what is pain behavior
his refers to what a person does in reaction to pain
define nociceptive pain
Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.”
define neuropathic pain
Pain caused by a lesion or disease of the somatosensory nervous system.”
define nociplastic pain
Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.”
which questionnaire can you use to assess neuropatic pain
DN4 questionnaire -> score of 4/10 indicate neuropathic
how many layer of clinical consideration for pain is there
7
which pain type is due to change in neurophysiology
nociplastic
what are the different model of pain
fear avoidant model of pain, avoidance-endurance model of pain
what are the 4 ways to do therapeutic communication
Listening
Pain validation
Pain neuroscience education
Familiar terms
give 4 benefit of therapeutic communication
↑ compassion
↑ hope/sel efficacy
↓maladaptive belief/fear
↓ stigmatization
why do we need to not use pain catastophizing in front of patient
may seem to dismiss the
medical basis of pain, question the authenticity of pain complaints, or blame individuals for their pain
what is pain catastiophizing
Pain catastrophizing is an exaggerated threat appraisal of one’s pain.
“an exaggerated negative
‘mental set’ brought to bear during actual or anticipated pain experience”
what is the most common way to measure pain catastrophizing
pain catastrophizing scale (PCS)
at which score on the PCS there’s priority to address PCS
> 20
what are the 3 step of pain catastrophizing
- rumination
- magnification
- helplessness
what do you need to do after admitstering the PCS
- homework: pain reaction journal
2.Review entries
Using patient’s story, show links between the pain experience vs. thoughts & feeling vs. what patient did (coping behaviour)
3.brainstorm alternative ways of coping
what is pain-related fear
mainly conceptualized as an emotional reaction that motivates protective behaviour
usually refers to fear of the pain itself or fear of doing physical movement/activity that could worsen the pain, injury, or cause re-injury.
what questionnaire can you give to assess pain-related fear
TSK-11 -> priority to address it when total score is >25
pain-related fear and fear-avoidant are emotional or behavior
pain-related: emotional
fear-avoidant: behavior
What is the purpose of using a patient-reported outcome measure, such as a questionnaire?
TO OVERCOME THE LIMITATIONS OF THE SUBJECTIVE (Narrative) ASSESSMENT
Patient-reported outcome measures are/have:
Standardized
* Psychometric properties: reliability, validity, etc.
* Limit bias (e.g., avoid leading questions/convo)
* Documentation quality: charting, legal, insurance, etc.
what is pain experience
defined as an unpleasant sensory and emotional experience, and is understood to be a function of the whole person.”
what is pain expression and contain what
the broad collection of qualitative words and behaviors that communicate pain”
pain narrative and pain behavior
what is pain narrative
“representing the words used to describe pain”
what are the two main element to assess pain
COMPASSION-BASED MANAGEMENT (humanistic, patient-centered)
MECHANISM-BASED MANAGEMENT (causation, multifactorial)
what is therapeutic alliance
a trusting connection and
rapport established between therapist and client through collaboration, communication, therapist empathy and mutual understanding and respect
what are the communication strategies to help with the narrative assessment
- gradually crossing levels of intimacy: ask what happen, describe pain, symptom, limitation than ask how it impact their life, thought and feeling
- OARS
- open-ended question: tell me about the injury
- affirming: Provide validation of the lived experience,
- reflecting:Reflect back
key points they said so that
with EMPATHY to
patient (repeat/paraphrase) the patient feels heard + you check your understanding
- summarizing: Provide validation of the lived experience,
Forward-pacing technique:
- Reflect (repeat/paraphrase) the last thing a patient said
➢ Jump ahead to where you think this story is going ➢And then use one of the prompts for follow-up questions
Fostering PATIENT AUTONOMY must be done in a _ way or else it won’t stick…
person-centered
what are the stage of change of the trans-theorical model
pre-contemplation
contemplation
preparation
action
maintenance
what are the 6 principles of trauma-informed care
- safety
- trustworthiness and transparency
- peer support
- collaboration and mutuality
- empowerment, voice, and choice
- cultural, historical, and gender issues
what is an active treatment
patient learns how to do the treatment from the therapist, and then applies it to themselves autonomously.
what is a passive treatment
the therapist applies the treatment to the patient; patient is on the receiving end.
T/F manual therapy is an effective to treatment for nociceptive and nociplastic pain
T
benefit of pain neuroscience education
painneuroscienceeducation” addressing unhelpful misconceptions or lack of knowledge about pain/injury/recovery process
what is exercise-induced hyperalgesia
when exercise’s “helpful” pain modulation mechanisms are reversed or weak.
what is pain continent
Let pain be my guide! ➢ May encourage
AVOIDANCE (problem with natural pacing vs. more intense functional pacing introduced as a treatment intervention) and HYPERVIGILANCE
what is time continent
Focus only on exercise / physical activity as prescribed (do it for the prescribed amount of time/reps/sets/frequency), regardless of whether pain increases during or after.
➢ May need to start pain- contingent first, then go to time-contingent.
during graded exercise what is the starting point
general (non-specific) aerobic or strength training focusing on unaffected body parts.
during graded exercise you will progress to
Specific strength training focusing on the affected body part
what are the strategies to responses to an overwhelmed patient
- LISTEN AND VALIDATE DISTRESS
(SHOW COMPASSION)
EXPLORE WHAT IS THE SOURCE OF THE DISTRESS (WHY UPSET?)
EVALUATE HOW THEY ARE COPING WITH THE DISTRESS
(DO THEY HAVE APPROPRIATE COPING RESOURCES?)
WHEN APPROPRIATE, GET BACK TO FOCUSING ON MANAGING THE PAIN/INJURY, OR
REFER OUT FOR ADDITIONAL SUPPORT.
what is trauma
experiences that cause intense physical and psychological stress reactions.
exemple of trauma
Types of trauma: - Developmental - Vicarious
- Historical
- Intergenerational - Cultural
- Vicarious
- Interpersonal
- Domestic violence - System-oriented
The odds of chronic pain in adulthood are nearly
double when ≥ _ACEs !
4
A key aspect of trauma-informed services is to
create an environment where service users do not experience further traumatization or re-traumatization (events that reflect earlier experiences of powerlessness and loss of control) and where they can make decisions about their treatment needs at a pace that feels safe to them.
T/F Insomnia increases the risk of depression.
T
T/F Sleep apnea is associated with an increased risk of stroke.
T
what are the 2 physiological force that govern the sleep cycle
homeostatic process -> sleep pressure
circadian process -> wakefulness pressure
what are the 2 hormones involves in sleep cycle
melatonin -> increase melatonin = increase sleepiness
cortisol -> increase cortisol = decrease sleepiness, increase wake up time
what is sleep deprivation
➢ Drowsiness
➢ Falling asleep very quickly
➢ Sleep hygiene tips can assist
➢ Make sleep a priority
insomnia exemple
➢ Being awake when you want to sleep
➢ Sleep hygiene tips might not be sufficient
➢ Cognitive behavioral therapy for insomnia (CBT-I) is recommended
definition of insomnia
Difficulties falling asleep, staying asleep and-or early awakenings without the possibility to go back to sleep
what can increase sleep apnea
Aging, weight gain, stroke, pregnancy and menopause
what is restlessness leg syndrome
Unpleasant sensations in the legs that appear at the end of the day and usually worsen in the evening
what can you prescribe to someone with insomnia
restricted bed time, stimulus control, relaxation, cognitive restructuration
what is the goal of restricted bed time
: Build sleep pressure and trigger a sleep rebound at the right moment o For example:
1. Sleep window of 6 hours to start
2. Regular sleep schedule for the whole week
