Exam

Question 1

Classification of chronic pain

Answer 1

ICD 11- chronic primary pain
Cacner related
post surgical/ post traumatic
neuropathic
Secondary HA or orofacial
Secodary visceral
Secondary musculoskeletsl

Question 2

Early life stress

Answer 2

immune reaction
increasedd SNS activity, decreased PNS
prolonged release of pro-inflammatory cyotkin
Interfereance with serotonin/ norepinephrine transmission to brain
Activation of glial cells at dorsal horn

Question 3

Psychosocial screen acronym

Answer 3

ACT UP
A-activities- how is pain affecting your life?
C- coping- how do you cope with your pain
T- think- do you think your pain will ever get better?
U- Uspet- are you worried or depressed abot your pain?
P-people- how do other people repsond when you have pain

Question 4

Outcome measures for pain

Answer 4

McGill: descriptors of pain + VAS + body chart
Leeds Assessment of neuropathic pain: 7 items,
Pain quality assessments scale- for neuropathic and nocicpetive pain, measures different aspect of pain (e.g. numbess, itchy, pressure) and rates it on a scale

Question 5

Chronic low back pain treatment efficacy

Answer 5

HVLA: moderate to high, good in ST for intensity, disability and mobility
Mobilisation: moderate, as above
Soft tissue: poor-moderate: positive in ST but poor evidence
Manual therapy + exercise: moderate, good in ST and LT espec with BPS

Question 6

Chronic neck pain treatment efficacy

Answer 6

CX HVLA and mobilisiation: moderate, TX HVLA poor to moderate, soft tissue poor,
positive in ST

Question 7

Tension type headaches treatment efficacy

Answer 7

HVLA, STT and mobilisation poor, only STT positive in short term

Question 8

Rotator cuff treatment efficiacy

Answer 8

mobilisation and HVLA moderate-
Manual therapy and exercise moderate
STT: poor

Question 9

Frozen shoulder treatmetn efficiacy

Answer 9

Mobilisation and HVLA: moderate

Manual therapy and exercise: moderate

Question 10

TMJ disorders treatment efficacy

Answer 10

massage and myofascial release: moderate-high
Cx/ Tx HVLA: poor-moderate
MT and exercsie: moderate

Question 11

Fibromyalgia treatmetn efficac

Answer 11

massge and myofascial release: poor-moderat, postiive in decreasing tenderpoint pain

Question 12

Exercise and chronic pain

Answer 12

exercise increases strength and flexibiity therefore reduce pain and improve function
exercise increases self efficacy, and decreases fear avoidance,
exercise decreases emotional stress
exerises incre. endogenos opioids, incre. pain ihibitor [pathways and decrease. pro inflamm cytokines

Question 13

Aerobic exercise and chronic pain

Answer 13

strongest pain reduction when workign in moderate to high intensity. exercise for 30 minutes

Question 14

Isometric exercise and chronic pain

Answer 14

effects pain perception on thresholds of intensity
Longer the duration= longer the hypoalgesic effect
Greatest chnages in pain happen at 5-9 minute makr
Isomentrics of non-painful areas alos hypoalgesic in pianful areas

Question 15

Stretching for chronic pain

Answer 15

Beneficial for CLBP if combined with strengthening

Question 16

Dynamic resisted training for chronic low back pain

Answer 16

• Aimed at improving neuromuscular control, strength and endurance of muscles that are key to maintaining spinal and trunk stability
• Good for CLBP, spondylolysis, spondylolisthesis

Question 17

Effect of exercise peripherlly

Answer 17

decrease inflam mediators, increase anti-inflam mediators
dorsal root ganglion: decrease inflam neurotransmitters
dorsal horn: decrease inflammatory neurotramistters from microglia, increae GABA
Brainstem: increase in 5Ht, opiods and decrease n inflammatory mediators

Question 18

Anti-inflammatory chemicals in exercise

Answer 18

During exercise IL=6 is released by skeletal muscle which is anti inflam
1L10, interlekin RA, TNFR-I and TNFR-II are released durng DOMS and they reduced cytokines and TNF-a

Question 19

Chronic muslce pain

Answer 19

sensitisation of muscle nocicpetors, inflammatory neurotransmitters (ATP), central activation of NDMA gligal celss, increased nerve density, increase DH excitability-thought to be the cause of allodynia nad hyperalgesia

Question 20

Tendon pain

Answer 20

tendionpathy occurs when there is overloading nad unable to withstand repeated tensile loading-> disrupion of cellular matrix (TNFa), vasculatiry (subtsance P) and neural growth, inreased firign of a delta nad c (TNFa), kineases reduce tendon strenght, change collagen,

Question 21

Bone pain

Answer 21

periosteum is innervated by nociceptors, a delta, a beta and c fibres, bone marrow also has nociceptos. Bone pain is felt from sensitisation of DH, increased activity by amygdala, PAG, hypothalamus, and NGF

Question 22

Joint pain

Answer 22

most common is OA, - Joint capsule, ligaments, periosteum, subchondral bone and menisci are innervated by myelinated & un-myelinated a-delta and unmyelinated C fibres , Synovial membrane innervated by C fibres, Articular cartilage is anueronal, treat with NSAIDs

Question 23

Mechanism of joint pain

Answer 23

During inflammation blood vessels become more permeable causing effusion and greater intra-articular pressure, Sensitisation of neurons in the joint-related structures , Changes in DH neurons, Reduced nociceptor thresholds, increased silent nociceptors