Exam 1- Pain Management Flashcards
what is an acute type of pain
less than 30 days
localized/defined
what is chronic type pain
3-6 months
nociceptive (PNS, CNS, SNS)
what is most reliable indicator for pain
subjective
what do we need to consider when choosing a measurement for pain
pt cognitive ability
symptom duration
time
what can we ask a patient to figure out their pain
location
duration
intensity
type
worse or better factors
radiates
sleep patterns
effects on ADLs
what are non verbal factors of pain
sighs
gasp
facial
restlessness
rubbing the area
vital sign
what is the primary sensation interpreted by the anterolateral spinothalamic pathway
crude touch
pain
temperature
what receives the signals in the anterolateral spinothalamic pathway
mechanoreceptors
nociceptors
thermoreceptors
what n/fibers are in the anterolateral spinothalamic pathway
c fibers
what is nociception
neural process of encoding noxious stimuli
what is pain
output of the brain triggered by action potential of nociceptor
what can inhibit nociception
modalities
what are the 3 dimensions of pain experience in the brain
sensory discriminative- where pain, how it feels
motivational affective- how the pt feels about the pain
cognitive evaluative- what the pt thinks about the pain and what they expect
what is located at the end of the afferent n
sensory receptors
what are free n endings
type of nociceptor/mechanoreceptor that sense pain
what are nociceptors triggered by
intense thermal, chemical, or mechanical
extrogenous
endogenous
what are afferent neurons of PNS
c fibers
a delta fibers
what are c fibers
small unmyelinated
dull, throbbing, aching
slow onset, long lasting symptoms
emotionally difficult
blocked by opiod
what are A delta fibers
longer, myelinated
sensitive to high intensity
sharp, stabbing
quick onset, short
localized
not blocked by opiods
what structural difference makes fibers faster than c fibers
myelin
where are the 1st order neurons housed
dorsal root ganglion
where do the 1st order neurons go after DRG
continue to spinal cord to Dorsal Horn turns to 2nd order
what neuro pathway does pain sensory travel in the CNS
spinothalamic tract
where do 2nd order neurons go after dorsal horn
anterolateral spinothalamic tract to thalamus where 3rd order is
where does the 3rd order neuron on the spinothalamic tract to terminate in the brain to be perceived as pain
primary somatosensory cortex
what can decrease the perception of pain
rubbing
moist heat
massage
increase stimulation of A beta fibers
how do endorphins work in the peripheral system
inhibitory actions causing presynaptic inhibition
act on C fibers
how do endorphins work in the central system
relieve pain naturally as they attach to reward centers in the brain
what is the role of the release of opiopetins
controlling pain during emotional distress
what are pain management goals
control inflammation
alter nociceptive sensitivity
increase opiod receptors
modify n conduction
management
what are the drawbacks of pharmacological agents
adverse side effects
may not be sufficient
risk of dependence
patient adherence
how does drugs control pain
modify inflammation mediators at periphery
alter pain transmission
alter central perception of pain
what are systemic agents
primary method of pain management
NSAIDS, etc
what are spinal analgesia
epidural or subarachnoid space of spinal cord
what are local injections
into structures or painful/inflamed area
what is the purpose of massage in rehab
local m excitation
increase mobility of adherent or shortened connective fascia
what can restrict motion
contracture
edema
adhesions
what is a contracture
soft tissue shortening of contractile or noncontractile
immobilization
what is scar tissue
over proliferation during this phase of healing causing too many cross-links
what is a muscle contracture
permanent shortening of m due to deformity
prolonged m spasm
guarding
m imbalance
immobilization
what is intraarticular edema
excessive fluid formation inside a joint capsule
restricts a capsular motion
what is extraarticular edema
outside a joint capsule
restricts motion in noncapsular pattern
what are adhesions
abnormal joining of different types of tissues causing resection
can cause scar tissue
what are treatment approaches to restricted motions
stretching
motion
sx
physical agents
what is plastic deformation
elongation produced under loading that remains after load is removed
what can cause plastic deformation over time
creep
stress relaxation
what interventions promote stretching
passive with thermotherapy
PNF
ballistic
what is massage used to treat
motion restrictions to increase soft tissue extensibility, control inflammation, control pain and facilitate motion
what motion treatments help limit motion restrictions
A/Prom
massage
thermotherapy
what can surgical release be used for
adhesions, contractures, of tissue limited by spasicity limitations
what physical agents help increase soft tissue extensibility
thermotherapy
massage
what physical agents help control pain and inflammation
cryotherapy
thermotherapy
ultrasound
light therapy
what physical agents help facilitate motion
traction
massage
what are physiological effects of massage
stretching/loosening adhesions
increased venous and lymphatic flow
decrease neuromuscular excitability
sedation
modulate pain
restore jt mobility
what are psychological effects of massage
sedation
lowers tension and anxiety
feeling of being helped
what are mechanical effects of massage
stretching a m
elongating fascia
mobilize adhesions
what are reflexive effects of massage
ANS
pain and circulation
what are indications for massage
swelling/edema
decreased ROM
m spasm
pain
HA
trigger point
what is effleurage
stroke glides over the skin lightly without attempting to move deeper m masses
what does effleurage help pinpoint
tightness
trigger point
m spasm
how does effleurage happen in UE/LE
stroking begins at peripheral and move toward heart
what is the purpose of effleurage
create warmth
flush out at end
create length in m
when does effleurage happen during the massage
beginning and end
what is petrissage
kneading manipulation that press and roll m
what is the process of petrissage
milking effect of tissue and loosening adhesions and increase venous return
what is the purpose of petrissage
increase venous and lymphatic
reduce m tension
press metabolic waste out
when is petrissage best used for treatment
break up adhesions
loosen adherent fibrous tissue
increase skin elasticity
perform distal to proximal
what is tapotement
brisk bouncy firm contact used to tone the m, form sagging skin, and increase circulation
what is the purpose of tapotement
increase circulation
stimulate subcutaneous structures
tone and firm m
what are the types of strokes for tapotement
hacking
cupping
beating
what is vibration
fine tremulous movement occuring to assist secretion removal from airway
when is vibration massage used
cystic fibrosis
COPD
how does friction massage affect the body
heavy compression over soft tissue will stretch scars and loosen adhesions
what is the purpose of friction massage
trigger point release
loosen fibrous scar tissue
aid in absorption of local edema
what is cross friction massage
used to treat chronic tendon inflammation
chronic overuse
what is the purpose of cross friction massage
increase inflammation to progress healing
break up adhesions
what is latent trigger point
no spontaneous pain but can restrict movement
what is active trigger point
causes pain at rest
TTP
referred pain
what is a jump sign
patient reacts to the over the trigger point
how do we treat a trigger point with massage
circular motion held longer and shorter treatment
what are the indications for IASTM
when hands can not create the necessary force or depth
excessive scar tissue
forms tendinitis or opathy
m and lig strains
plantar fascitis and ITB
what is functional massage
combines passive or active mobilization of the jt
good for stretch and collagen alignment
adds stretch and m compression
what is a strain counterstrain
preposition in a relaxed initial position by shortening the m
what is active release technique
combo of specific m movement and specific direct pressure
