DEVELOPING CRITICALITY Flashcards
Define pain
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. (IASP, 2020)
What is the nociceptive pain mechanism?
Pain in a specific part of the body related to movement.
Pathological process in peripheral organs and tissues. Pain projection into damaged body part or referred pain. Pain in a localised part of the body which is related to movement, usually a dull ache.
Nocioceptors can be stimulated by thermal, mechanical and chemical factors
Pain arising from the activation of the nociceptors is called nociceptive pain. Nociceptive pain can be classified according to the tissue in which the nociceptor activation occurred: superficial somatic (e.g. skin), deep somatic (e.g. ligaments/tendons/bones/muscles) or visceral (e.g. internal organs).
What is the neuropathic pain mechanism?
Pain which is burning, shooting, sharp, or like an electric shock.
Pain caused by lesions or disease of the somatosensory nervous system. Nerve pain, a more severe shooting pain. Indictaes potential nerve damage.
What is the nocioplastic pain mechanism?
Pain that arises from altered nociception despite no clear evidence of actual tissue damage. Activation of peripheral nociceptors or evidence for disease of the somatosensory system. Wider spread pain with no evidence for tissue damage eg fibromyalgia.
What is the central sensitisation pain mechanism?
An increased responsiveness of nocioceptors in the central nervous system to either normal or sub threshold afferent input resulting in HYPERSENSITIVITY to stimuli. Associated with wide spread pain.
Define ontology
Concerned with the fundamental nature of the world
Define epistemology
the theory of knowledge, especially with regards to its methods, validity and scope, and the distinction between justified belief and opinion.
What does science set out to do?
To falsify claims. To disprove enough evidence. Going against the null hypothesis.
Define methodology?
The framework or strategy to do the work
Define research
The systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions.
What is evidence based healthcare based on?
Best of research
Patient values
Clinical expertise
What are the levels of research evidence?
1a - systematic reviews of randomised controlled testing
1b - individual randomised controlled tests
1c- all or nothing trials
2a - SRs of cohort studies
2c - outcome studies, ecological studies
3a - SRs of case control studies
3b - individual case control studies
4 - case series
5 - expert opinion
What research leads to a non-causal claim?
Cohort studies
Case-control studies
case series
case reports
opinion
What research leads to a causal claim?
Systematic review of randomised control testing with or without meta-analysis
RCTs
(comparative studies)
Define regression to the mean?
The natural phenomenon whereby an individual’s pain gets better and worse naturally, with or without treatment.
What methods have causal claims?
CBT
Hydrotherapy
Manipulation
Exercise
What is allodynia?
Painful response to a normally non-painful stimuli
What is hyperalgesia?
Exaggerated painful response to a normally mildly painful stimuli.
What is TSP?
A progressive increase in pain perception in the response to repeated stimuli of the same intensity (temporal summation) eg someone performing knee exercises may complain of increasing levels of pain the more repitions of the same exercise they perform, which can be attributed to TSP.
What is the Keele STarT Back tool?
A questionnaire consisting of yes and no questions, which help categorise a patient into High, Medium and Low risk
High - additional pshychological obstacles to recovery: enhanced package of care, BPS approach
Medium - mainly physical obstacles to recovery: good quality physio treatment
Low - low risk of chronicity: advice, reassurance, medication
What are the four ethical principles?
Autonomy
Beneficence
Nonmaleficence
Justice
What is base rate fallacy?
Where people tend to ignore the base rate
eg there are more sales people than librarians example
What is the SPIN acronym?
Specific
Positive test
Rules the condition in
eg if positive ottawa ankle test, rules the condition in but at a low rate of probability as this test has a low specificity.
What is the SNOUT acronym?
Sensitivity
Negative
Rules of condition out
eg if negative ottawa ankle test (as high sensitivity) can assume that an ankle fracture probably is not present.
What is a randomised control trial?
Test whether an intervention works by comparing it to a control condition, either no intervention (placebo), or an alternative intervention (treatment as usual).
