Final Exam Flashcards
Definition of hypoalgesia
Diminished pain in response to a normally painfull stimulus
Définition of hyperalgesia
I creased pain from a stimulus that normally provokes pain
Définition of allodynia
Pain due to a stimulus that does not normally provoke pain
Pain threshold definition
The minimum intensity of stimulus that is perceived as painful
Pain tolerance
The maximum intensity of a pain producing stimulus that a subject os willing to accept in a given situation
Pain behaviour
What a person does in resction to pain or to express pain
Ex: avoidance, withdrawal, crying, grimacing
Stress response systems
Hpa axis
Autonomic ns
Endocrine system
Cardiovascular system
Nociceptive pain
Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors
Neuropathic pain
Pain caused by a lesion or disease of the somathosensory nervous system
Nociplastic pain
Pain that arises from altered nociception despite no clear evidence of actuà or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain
Purpose of pain
Detect threat
Motivate protective behaviour
Why bot use pain carastrophizing with pt
- dismiss the medical basis of pain
- question authenticity of pain complaints
- blame indv for their pain
Def of pain catastrophizing
Is an exaggerated threat apprasial of pain (understanding)
Advatages of patient reported outcome measures
- standardized
- psychometric properties (reliability, validity)
- limit biais
- documentation quality
Purpose of patient reported outcome measure, such as questionaire
- screen
- evaluate
- prioritize
- inform
- to re-assess
- to motivate
Pain experience
Unpleasant sensory and emotional experience, and is understood to be a function of the whole person
Pain expression
Broad collection of qualitative words and behaviours that communicate pain
- pain narrative (words)
- pain behaviour (non-verbal and praverbal behaviour)
Pain measures
Quantitative tools used to assess pain
- self reported measures (questionaires)
- non self report ( imaging)
Definition of pain
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
Imp to listen and validate why
Therapeutic alliance
Person feels heard they stop wasting energy on trying to prove to you that their pain is real, more engaged in disclosure of relevant info
Principles of pain management
Patient autonomy
Therapeutic àalliance
Layers of clinical considerations for pain
Therapeutic alliance
A trusting connection and rapport established between therapist and client through collaboration, communication, therapist empathy and mutual understanding and respect
Mechanism based approach to pain management: nociceptive
Exercise
Massage
Tens
Mechanism based approach to pain management: nociplastic
Education
Exercise
Massage
Manipulation
TENS
Mechanism based approach to pain management: neuropathic
Exercise
Mechanism based approach to pain management: psychosocial
Education
Exercise
Massage
Mechanism based approach to pain management: motor
Education
Exercise
Manipulation
Principles of trauma informed care
Safety
Trustworthiness and transparency
Peer support
Collaboration and mutuality
Enpowerment, voice, and choice
Cultural,historical and gender
clarification of definition of pain
- personal experience
- pain does not equal nociception
- affected by life exp
- pt report respected
- affects psychosocial aswell
- many behaviours to pain (verbal to non-vebal)
central sensitization what happens in body
- increased responsiveness of nociceptive neurons in the CNS to their normal or sub threshold afferent input
- increased size of receptive fields for nociceptive spinal dorsal horn neurons
- reduced threshold of nociceptive spinal dorsal horn neurons to stimulation of their receptive fields
- temporal summation of pain = prig increase of pain to the same stim administered repetitively or over long period
peripheral sensitization what happens in body
- increased respnsiveness 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
pain related fear definition
refers to fear of the pain itself or fear of doing physical mvt/activity that could worsen the pain, injury, or cause re-injury
explain guided disclosure
gradually cross levels of intimacy
explain OARS
Open ended questoins
A: affirming (validate feelings not not bad behaviour)
R: reflecting (empathy)
S: summarize (main problems and needs)
explain motivational interviewing
R: resist (not telling them what to do)
U: understand (what motivates them)
L: Listen (empathy)
E: empower (support autonomy)
explain forward pacing
increase pace of disclosure
skip necessary dialogue
reflect what the patient says and follow with an open ended question to direct convo to imp part
why is it imp to educate pt
- pain neuroscience education addressing unhelpful misconception or lack of knowledge about pain/injury/recovery
- setting expectations
- modifying maladaptive coping habits
- modifying training
- daily life/ lifestyle habits for recovery, prevention and overall health
benefits of active tx
- empower patient autonomy
- internal locus of control
- building self-efficacy
- motivation for long-term adherence to improved lifestyle habits
- better, faster recovery + prevention of recurrence
how to apply pain neuroscience education
- leverages the communication strategies (oars, rule, etc)
- consider which bps factors are relevant to talk about
- gauge the extent/depth to which the patient cares to talk about it (pt centered)
- evidence-based, collaborative & empathetic
two components of sleep physiology
homeostatic process
circadian rhythm
explain homeostatic process
sleep pressure
build up through time awake
feel more sleepy and get better sleep rebound if high pressure
lowers with naps
explain circadian rhythm
internal clock
dictates when to sleep and when to be awake
affected by light (natural and blue from screens)
dark increases melatonin
components of cognitive behavioural therapy for insomnia CBT-I
- sleep diary
- sleep hygiene
- restricted time in bed
- stimulus control
- relaxation
- cognitive restructuration
responding to an overwhelmed/distress pt
- listen and validate
- explore what is the source of the distress
- evaluate how they are coping with the distress
- when appropriate, get back to focusing on managing the pain/injury, or refer out for additional support
