Exam 1 Treatment of Central Sensitization Pain Flashcards
what three things are we using to treat
PNE
stress management
graded activity and exercise therapy
what is the overall goal of PNE
teach about pain, reconceptulaize it, reduce the threat and less fear
how does stress work
the hypothalamus sends signals to the pituitary gland which goes to the adrenal gland and then releases cortisol and EPI and NE
when we are stressed, there is an increase in cortisol and NE, and what does this do to the brain
increases excitatory synapses in the hippocampus amygdala and prefrontal cortex
central sensitization entails…
a change in the synaptic efficiency. More NT and synapses and receptors to transmit pain signals
how does stress lead to central sensitization
GABA and serotonin decreases, so there is less inhibition, and you get higher levels of central sensitization
what can decrease stress and pain
mindfulness, medications nd Schultz relaxation
does walking and movement increase or decrease the firing of the pain matrix
decreases the firing
what must exercise address with cognitive emotional sensitization
catastrophizing, kinesiophobia, stress, depression
should we ever say
“I stop gardening when it hurts”
“or tell me when it hurts and we will stop”
no because you are saying there will be more pain, which will cause them more pain
TF: we want to flare people up and tell them to work through the pain and we want to cause them pain
false
are isometric exercises good
no, can flare up
eccentrics?
can flare them up
TF: we can do exercises with activity pacing to decrease flaring up and promote recovery
true
what is a treatment program look like
PNE, stress, activity self management, graded exposure, recovery
what is the fear center
amygdala
normally, what happens with loops in the brain
the loops try to override to signal saying hey remember this, and the pain and the experience
TF: we must train in painful positions with our athlete do we do not let their body remember the motion and equate it to pain
true think tennis player
do we get angry with pain
yes, we think about previous injustice and anger
movement may trigger fear in what region
amygdala
TF: movement patterns change because we anticipate pain
true
how can we initially start a training program
have the patient think about activity, or their pain, and watch someone else do it to ease back into it, graded exposure
how can we retrain the memory of fear
ask them what we think will hurt it, and on a scale of 1-100. then ask them why? and explain to them, challenge their beliefs
central sensitization take home messages
PNE first
then stress to reduce the central sensitization
then graded activity and exercise to dampen things
then exercise and retraining memories.
