interventions midterm Flashcards
what is pne utilized for
healthier responses to pain
nociceptive pain
short duration
well localized
neuropathic pain
pain travels
neuroplastic plain
persistant, chronic
spread in non dermatomal pattern
intensity out of proportion
pain neuroscience education
change belief that pain is marker of injury or disease
is there a pain signal or center in the brain?
no
pain is an experience
what is pain?
appraisal made by our protection system based on neural representation of threat/danger
our knowledge of pain is limited
its still in infancy
its complex - opioid epidemic didn’t solve it.
still learning about chronic pain
MOM (mature organism model of pain)
we evolved to tolerate pain
helps us to survive and pass on genes
stress response
pain helps us avoid bad things
What would happen if we didnt feel pain?
may not survive to adulthood
harm themself
dont realize they are hurt
what is the brain’s role in MOM?
continual sampling of the outside environment, own body, and relevant past experiences
experiences coded into memories
through what process does the brain scrutinize during MOM?
somatic: muscles
autonomic: subconscious control of body
neuroendocrine
immune
3 dimensions of pain in MOM
sensory: anatomical descriptions
cognitive: thoughts
affective: emotional reaction
how does MOM guide treatment?
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)
input not mandatory
some neural processes can act in the absence of any inputs
stress and depression can cause physical pain
phantom pain in amputees
role of neural networks
suggests origins of patterns which underlie experiences lie in brain neural networks
the self
body perceived in unity
pain breaks the unity
genetic compenent
may explain why some are more at risk for chronic pain or maladaptive pain
neuroignature/neurotag
synaptic arrangement of multiple centers in the brain
modulated by protection being highest priority
fired together are wired together
thoughts affect ability
failed homeostasis equals
conditions producing chronic pain
cortical smudging
poor localization
blurring of pain map
need to retrain where the body is
biomedical approaches
medical/pharm treatments
anatomic education
emphasis on pain not function
facilitating avoidance
all have poor - modest results
biopsychosocial approach
emphasize PNE
develop therapeutic alliance with pt
focus less on diagnosis and more on changing maladaptive behaviors
central sensitization
become efficient at feeling pain
increase perception of pain in other regions
changes in properties in neurons
CNS is now on higher alert
allodynia
normally benign stimulus
cold, heat, light touch
hyperalgesia
increased perception of noxious stimulus
secondary hyperalgesia
spread beyond initial injury site
catastrophizing
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
ruminating
overthinking and worrying about pain
pain related outcomes
increased behavioral pain expressions
more illness
higher pain severity
alterations in social support networks
partner either overprotective or over it
how can you treat catastrophizing?
graded exercise or exposure
hurt doesn’t equal harm
fear avoidance
avoid movement
over guarding
find what they can do
do not say “avoid what hurts”
role of stress on pain
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
stress-pain likelyness
7-8x more likely to develop chronic pain
cortisol
helps respond to stress
good for ST, but not for LT
what is the LT stress effect?
if cortisol fails to function, we run out of fuel
lead to lack of other hormones
hypo-corisolism
parasym and sym out of wack
never get to rest and digest
locus of control
generalized attitude or belief regarding causality
benefits of internal: what can I control?
hierarchy of listening
ignore message
pretend to listen
selective listening
attentive listening
empathetic listening
three levels of maladaptive cognition
core beliefs
dysfunctional assumptions
negative automatic thoughts
progressive relaxation
paired with mindfulness techniques to being sensory levels down to manageable level
motivational interviewing
toward behavioral change, some aspects very good for establishing rapport and trust
express empathy
develop discrepancy
roll with resistance
support self efficacy
4 pillars of PNE
educate about pain
aerobic exercise
sleep hygiene
goal setting
PNE
emphasizes that any credible evidence of danger to body tissues can increase pain and any credible evidence of safety can decrease pain
pain education
don’t overload
therapeutic alliance
not hands off
avoiders
fearful of movement tasks
“I can’t”
slowly but surely
they don’t do enough
persisters
do too much
“I have to”
need to stop the boom vs bust
graded exercises
for avoiders
small amounts to build up
hurt doesnt equal harm
sore but safe
pacing exercises
for persisters
slow them down
don’t let them go crazy
goals: functional and fun
5 rules to move despite pain
focus on LT benefits not ST pain
improve beliefs first
only grade avoided
improve stress tolerance
improve sleep self-management
how sleep affects pain
happy hormones decline when you lack sleep
dopamine regulates sleep
reccomendations for taking care of YOU when treating chronic pain pts
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
factors predicting burnout
limited self-awareness
inability to set professional and personal boundaries
limited control over scheduling
mounting time pressures
negative attitudes toward psychosocial care
attitudes and beliefs
what do you think is the cause of your pain?
what info is gained?
fear/avoidance
catastophization
maladaptive beliefs
passive attitude toward rehabilitation
expectations of effect of activity or work on pain
behaviors
what are you doing to relieve your pain?
what info is gained?
use of extended rest
reduced activity levels
withdrawal from ADLs and social activities
poor sleep
boom-bust behavior
self-medication - alcohol or other substances
compensation issues
is your pain placing you in financial difficulties?
what info is gained?
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
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?
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
emotions
is there anything that is upsetting or worrying you about the pain at this moment?
what info is gained?
fear
depression
irritability
anxiety
stress
social anxiety
feeling useless or not needed
family
how does your family react to your pain?
what info is gained?
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
work
how is your ability to work affected by your pain?
what info is gained?
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
OARS
open questions
affirmations
reflective listening
summarizing
positive body language signals
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
negative body language signals
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
soft tissue manual therapy indications
tendonopathy, tendonosis
myofascial pain syndromes
trigger points
ligament pain syndromes
scar tissue adhesion
entrapment syndromes
myofascial release
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
myofascial release techniques
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
pin and stretch, bend and stretch, ART
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)
cross friction massage
for tendon junctions
perpendicular or circular motion
created small microtrauma to get collagen synthesis
ischemic compression/trigger point release
trigger point is hypertonicity
several factors: mechanical stress, poor posture, insufficient hydration, inadequate sleep
may take 30-45 seconds
strumming is more aggressive
instrument assisted soft tissue mobilization
using instrument to assist
saves your hands
uses lubricant
alcohol to remove lubricant from skin
break up irregular abnormal densities in tissues
optimal treatment window
2-12 weeks post injury
effects of IASTM
increased fibroblastic activity
davis law: lengthen or shorten based on the forces or lack of forces placed on them
IASTM strokes
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
what does generalized central sensitization sound like?
I have persistent pain and don’t know why.
no catas, rum, fear, stress, or locus issues
can get better with education about PNE
foot stepping on nail card
when step on nail, alarm goes off. this is normal
sometimes the alarm doesnt shut off or can be easily retriggered
before pain/after pain card
the continued pain is a nerve problem not tissue
pain alarm goes off despite no tissue damage or threat
leaf card
house alarm sets off because of a leaf blowing by. there is no threat.
this happens to 1 in 4 individuals
nosy neighbors card
other systems in body get altered when nervous system becomes overactive.
this explains why you might have GI problems, sleep problems, ect
lion card
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.
hurt does not equal harm card
sore can still be safe
can you walk a minute?
graded exercises
runner card
exercise produces natural chemicals like opioids without the side effects.
can help to lower sensitivity of nervous system
car dashboard card
check engine light is on, but the car is actually ok
keep calm and move on to help decrease pain
body card
we can tolerate stress when functioning correctly.
injuries can be more complicated when stress is involved
boiling cup card
stressors act as an open flame heating your cup
fears, anxiety and frustration only exacerbate sensitivity in nervous system
teeter totter card
sympathetic not designed to run for long periods of time
would pain be better if you could relax more?
measuring cup and alarm card
increased emotion actives alarm
how can you reduce your stress?
storm cloud card
increased stress chemicals create side effects
could all this be tied to your pain?
tissue vs pain problem card
the more you know about pain, the lees you will experience
car pile up card
only 2-3% of demo drivers experience long lasting pain
spine card
40% of bulging discs produce no pain
discs fluctuate quite a bit during the day
graph card
develop a little arthritis in 20’s
arthritis and back pain are not causal
