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fall A 2024 > interventions midterm > Flashcards

interventions midterm Flashcards

1
Q

what is pne utilized for

A

healthier responses to pain

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2
Q

nociceptive pain

A

short duration
well localized

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3
Q

neuropathic pain

A

pain travels

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4
Q

neuroplastic plain

A

persistant, chronic
spread in non dermatomal pattern
intensity out of proportion

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5
Q

pain neuroscience education

A

change belief that pain is marker of injury or disease

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6
Q

is there a pain signal or center in the brain?

A

no
pain is an experience

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7
Q

what is pain?

A

appraisal made by our protection system based on neural representation of threat/danger

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8
Q

our knowledge of pain is limited

A

its still in infancy
its complex - opioid epidemic didn’t solve it.
still learning about chronic pain

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9
Q

MOM (mature organism model of pain)

A

we evolved to tolerate pain
helps us to survive and pass on genes
stress response
pain helps us avoid bad things

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10
Q

What would happen if we didnt feel pain?

A

may not survive to adulthood
harm themself
dont realize they are hurt

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11
Q

what is the brain’s role in MOM?

A

continual sampling of the outside environment, own body, and relevant past experiences
experiences coded into memories

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12
Q

through what process does the brain scrutinize during MOM?

A

somatic: muscles
autonomic: subconscious control of body
neuroendocrine
immune

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13
Q

3 dimensions of pain in MOM

A

sensory: anatomical descriptions
cognitive: thoughts
affective: emotional reaction

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14
Q

how does MOM guide treatment?

A

therapeutic interventions (change tissue inputs)
therapeutic interactions (change environmental input - sleep better, stimulate parasympatetic)
therapeutic reframing (change brain’s self-sampling input via therapeutic neuroscience education)

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15
Q

input not mandatory

A

some neural processes can act in the absence of any inputs

stress and depression can cause physical pain
phantom pain in amputees

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16
Q

role of neural networks

A

suggests origins of patterns which underlie experiences lie in brain neural networks

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17
Q

the self

A

body perceived in unity
pain breaks the unity

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18
Q

genetic compenent

A

may explain why some are more at risk for chronic pain or maladaptive pain

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19
Q

neuroignature/neurotag

A

synaptic arrangement of multiple centers in the brain
modulated by protection being highest priority
fired together are wired together
thoughts affect ability

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20
Q

failed homeostasis equals

A

conditions producing chronic pain

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21
Q

cortical smudging

A

poor localization
blurring of pain map
need to retrain where the body is

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22
Q

biomedical approaches

A

medical/pharm treatments
anatomic education
emphasis on pain not function
facilitating avoidance

all have poor - modest results

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23
Q

biopsychosocial approach

A

emphasize PNE
develop therapeutic alliance with pt
focus less on diagnosis and more on changing maladaptive behaviors

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24
Q

central sensitization

A

become efficient at feeling pain
increase perception of pain in other regions
changes in properties in neurons

CNS is now on higher alert

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25
Q

allodynia

A

normally benign stimulus

cold, heat, light touch

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26
Q

hyperalgesia

A

increased perception of noxious stimulus

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27
Q

secondary hyperalgesia

A

spread beyond initial injury site

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28
Q

catastrophizing

A

worse case thinking
interpersonal coping style
affects family and caregivers

Let every photograph be taken from my bad side
So when the world sees my face
They’ll never ask why
I look the way I do

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29
Q

ruminating

A

overthinking and worrying about pain

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30
Q

pain related outcomes

A

increased behavioral pain expressions
more illness
higher pain severity
alterations in social support networks

partner either overprotective or over it

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31
Q

how can you treat catastrophizing?

A

graded exercise or exposure
hurt doesn’t equal harm

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32
Q

fear avoidance

A

avoid movement
over guarding
find what they can do
do not say “avoid what hurts”

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33
Q

role of stress on pain

A

HPA axis (hypothalamus-pituitary adrenal axis)
activated during periods of stress and homeostatic imbalance

amygdala activates HPA during stress
hypothalamus releases CRH
pituitary gland secretes ACTH
ACTH acts to release cortisol from adrenals

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34
Q

stress-pain likelyness

A

7-8x more likely to develop chronic pain

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35
Q

cortisol

A

helps respond to stress
good for ST, but not for LT

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36
Q

what is the LT stress effect?

A

if cortisol fails to function, we run out of fuel
lead to lack of other hormones

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37
Q

hypo-corisolism

A

parasym and sym out of wack
never get to rest and digest

38
Q

locus of control

A

generalized attitude or belief regarding causality
benefits of internal: what can I control?

39
Q

hierarchy of listening

A

ignore message
pretend to listen
selective listening
attentive listening
empathetic listening

40
Q

three levels of maladaptive cognition

A

core beliefs
dysfunctional assumptions
negative automatic thoughts

40
Q

progressive relaxation

A

paired with mindfulness techniques to being sensory levels down to manageable level

41
Q

motivational interviewing

A

toward behavioral change, some aspects very good for establishing rapport and trust

express empathy
develop discrepancy
roll with resistance
support self efficacy

42
Q

4 pillars of PNE

A

educate about pain
aerobic exercise
sleep hygiene
goal setting

43
Q

PNE

A

emphasizes that any credible evidence of danger to body tissues can increase pain and any credible evidence of safety can decrease pain

44
Q

pain education

A

don’t overload
therapeutic alliance
not hands off

45
Q

avoiders

A

fearful of movement tasks
“I can’t”
slowly but surely
they don’t do enough

46
Q

persisters

A

do too much
“I have to”
need to stop the boom vs bust

47
Q

graded exercises

A

for avoiders
small amounts to build up

hurt doesnt equal harm
sore but safe

48
Q

pacing exercises

A

for persisters
slow them down
don’t let them go crazy
goals: functional and fun

49
Q

5 rules to move despite pain

A

focus on LT benefits not ST pain
improve beliefs first
only grade avoided
improve stress tolerance
improve sleep self-management

50
Q

how sleep affects pain

A

happy hormones decline when you lack sleep
dopamine regulates sleep

51
Q

reccomendations for taking care of YOU when treating chronic pain pts

A

longer treatment times
limiting the numbers of chronic patients in a day
some wont buy what you are selling
threats and stress can affect you as well
provide a pathway not an absolute cure

52
Q

factors predicting burnout

A

limited self-awareness
inability to set professional and personal boundaries
limited control over scheduling
mounting time pressures
negative attitudes toward psychosocial care

53
Q

attitudes and beliefs
what do you think is the cause of your pain?

what info is gained?

A

fear/avoidance
catastophization
maladaptive beliefs
passive attitude toward rehabilitation
expectations of effect of activity or work on pain

54
Q

behaviors
what are you doing to relieve your pain?

what info is gained?

A

use of extended rest
reduced activity levels
withdrawal from ADLs and social activities
poor sleep
boom-bust behavior
self-medication - alcohol or other substances

55
Q

compensation issues
is your pain placing you in financial difficulties?

what info is gained?

A

lack of incentive to return to work
disputes over eligibility for benefits, delay in income
assistance
history of previous claims
history of previous pain and time off work

56
Q

diagnosis and treatment
you have been seen and examined for your pain?
are you worried that anything may have been missed?

what info is gained?

A

health professional sanctioning disability
conflicting diagnoses
diagnostic language leading to catastrophizing and
fear
expectation of “fix”
advice to withdrawal from activity and/or job
dramatization of back pain by health professional
producing dependency on passive treatments

57
Q

emotions
is there anything that is upsetting or worrying you about the pain at this moment?

what info is gained?

A

fear
depression
irritability
anxiety
stress
social anxiety
feeling useless or not needed

58
Q

family
how does your family react to your pain?

what info is gained?

A

over-protective partner/spouse
solicitous behavior from spouse
socially punitive responses from spouse
support from family for return to work
lack of support person to talk to

59
Q

work
how is your ability to work affected by your pain?

what info is gained?

A

history of manual work
job dissatisfaction
belief work is harmful
unsupportive or unhappy current work environment
low educational background
low socio-economic status
heavy physical demands of work
poor workplace management of pain issues
lack of interest from employer

60
Q

OARS

A

open questions
affirmations
reflective listening
summarizing

61
Q

positive body language signals

A

sitting on edge of seat
standing, hands on hip
tilted head
moving closer
rubbing palms together
uncrossed arms
body leaning forward
hand on cheek
touching chin
relaxed mouth, chin forward

62
Q

negative body language signals

A

rocking motion of torso
downcast eyes/lack of eye contact
arms crossed
leg or foot swinging
foot or finger tapping
short breaths/sighing
wringing hands
slumping in chair/fidgeting in chair
lowering of chin
hunched shoulders
fist clinched
legs crossed
body turned slightly away
grooming
yawning
signs of being nervous

63
Q

soft tissue manual therapy indications

A

tendonopathy, tendonosis
myofascial pain syndromes
trigger points
ligament pain syndromes
scar tissue adhesion
entrapment syndromes

64
Q

myofascial release

A

mild combo of pressure and stretch used to free ST restrictions particularly in the fascia

john burns

no oils or emollients
slow holds
larger areas
cross handed techniques

65
Q

myofascial release techniques

A

45 degree stroke: maintain pressure and wait for CT to unwind
skin rolling: start with direction of ease and reverse to direction of restriction
C-stroke: variation of skin rolling when difficult to lift and grasp tissues in a roll

66
Q

pin and stretch, bend and stretch, ART

A

combo of precisely directed tension with very specific patient movements. pin down muscle in shortened position and elongate away from stretched position.

muscular
acute conditions, smaller areas
hypoxia (scar tissue)

67
Q

cross friction massage

A

for tendon junctions
perpendicular or circular motion

created small microtrauma to get collagen synthesis

68
Q

ischemic compression/trigger point release

A

trigger point is hypertonicity

several factors: mechanical stress, poor posture, insufficient hydration, inadequate sleep

may take 30-45 seconds
strumming is more aggressive

69
Q

instrument assisted soft tissue mobilization

A

using instrument to assist
saves your hands
uses lubricant
alcohol to remove lubricant from skin

break up irregular abnormal densities in tissues

70
Q

optimal treatment window

A

2-12 weeks post injury

71
Q

effects of IASTM

A

increased fibroblastic activity
davis law: lengthen or shorten based on the forces or lack of forces placed on them

72
Q

IASTM strokes

A

sweep: broom
fan: turns around axis
brush: shorter sweeps
strum: guitar
swivel: back and forth scoops
j-stroke: making j shape
scoop: dig down and then lift up along edge
framing: rectangular direction

73
Q

what does generalized central sensitization sound like?

A

I have persistent pain and don’t know why.
no catas, rum, fear, stress, or locus issues
can get better with education about PNE

74
Q

foot stepping on nail card

A

when step on nail, alarm goes off. this is normal
sometimes the alarm doesnt shut off or can be easily retriggered

75
Q

before pain/after pain card

A

the continued pain is a nerve problem not tissue
pain alarm goes off despite no tissue damage or threat

76
Q

leaf card

A

house alarm sets off because of a leaf blowing by. there is no threat.
this happens to 1 in 4 individuals

77
Q

nosy neighbors card

A

other systems in body get altered when nervous system becomes overactive.
this explains why you might have GI problems, sleep problems, ect

78
Q

lion card

A

we have evolved to sense danger to stay alive
the fear we have now is not the same fear we had but our body still reacts the same.

79
Q

hurt does not equal harm card

A

sore can still be safe
can you walk a minute?

graded exercises

80
Q

runner card

A

exercise produces natural chemicals like opioids without the side effects.
can help to lower sensitivity of nervous system

81
Q

car dashboard card

A

check engine light is on, but the car is actually ok
keep calm and move on to help decrease pain

82
Q

body card

A

we can tolerate stress when functioning correctly.
injuries can be more complicated when stress is involved

83
Q

boiling cup card

A

stressors act as an open flame heating your cup
fears, anxiety and frustration only exacerbate sensitivity in nervous system

84
Q

teeter totter card

A

sympathetic not designed to run for long periods of time
would pain be better if you could relax more?

85
Q

measuring cup and alarm card

A

increased emotion actives alarm
how can you reduce your stress?

86
Q

storm cloud card

A

increased stress chemicals create side effects
could all this be tied to your pain?

87
Q

tissue vs pain problem card

A

the more you know about pain, the lees you will experience

88
Q

car pile up card

A

only 2-3% of demo drivers experience long lasting pain

89
Q

spine card

A

40% of bulging discs produce no pain
discs fluctuate quite a bit during the day

90
Q

graph card

A

develop a little arthritis in 20’s
arthritis and back pain are not causal

fall A 2024 (10 decks)

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