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Pain science > Intro to pain science > Flashcards

Intro to pain science Flashcards

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1
Q

what is a general experience for someone with chronic pain?

A

those with chronic pain suffer bc they dont feel believed and have been on a recovery cycle for a long time

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2
Q

What is the mind body link?

A

drawing a timeline to understand emotional impact BEFORE, DURING and AFTER the trauma onset

  • this helps address underlying anxiety depression
  • doing this early is critical for long term pn mgmt
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3
Q

What are tips for pn mgmt following the mind body link principle ?

A
  • address anxiety and depression early
  • find positive and ongoing support, pts could feel isolated
  • practical sleep improvements
  • regular exercise and activity
  • good nutrition
  • knowledge about pain
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4
Q

What did we learn from the rubber hand illusion ?

A
  • the sense of body is malleable

- we can trick our brain into thinking a rubber hand is our own, and to protect the and by “sensing” pn

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5
Q

What are examples of body information analyzed by our bodies?

A

Our body understands information by gathering data from body sources such as muscles, bones, tendons, fascia, organs, immune system endocrine system and our body chemistry.

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6
Q

The “person” does not know anything about our body without what type of tissue ?

A

the nervous system

  • the NS tells us about blood flow, chemistry, movement, temperature
  • impulses are carried to brain to make decisions about pn. the environment must also be considered
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7
Q

What are examples of environment information analyzed by our bodies?

A

physical properties such as if we are in the home or clinic

  • mood/ emotion
  • sleep
  • social person/ work factors ; pn is expressed differently around a boss or child
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8
Q

Do memories change our perception and reaction to painful stimuli ?

A

yes
pn is reviewed in 9 different areas in the brain that determine how pain is processed and how it is handled. how it is processed and expressed.
each center can form memories and can in turn give us “warnings” on how to react in the future with similar environmental situations or stimuli

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9
Q

what are protection memories?

A

arise from previous injuries or pain to form thoughts and beliefs about pn and injury

  • “what have I or others done that has or hasnt helped?”
  • protection memories can becomes chemistry - electricity and nerve impulses that become part of the review process when pain is analyzed in the brain by the 9 diff areas
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10
Q

What are inputs for pain signals to the brain?

A

environment info, body info

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11
Q

what are outputs of the body caused by pain?

A

pain, changes in physiology and movement

  • phyio
    changes in physiology can occur in the endocrine and immune systems as a result of pain

Movement
strategies for protection that are enabled by the body as a pain response, may manifest as muscle or fascia tension trigger points, or joint stiffness and therefor change movement patterns

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12
Q

can changes in physiology can occur in the endocrine and immune systems as a result of pain ?

A

yes

the brain can decide how much inflamation is sent to specific parts of the bosy or whole body

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13
Q

Can movement can be changes as a result to pain ?

A

yes b.c movement changes with pain, the output can now become an input

BUT pain experience cant be input into the body

  • the changes mean that our experince can change how we feel about things
  • this is why pain is complicated
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14
Q

Is pain bad? Shoudl we get rid of it entirely?

A
  • no and no
  • pain can be protective from fx and be used as an alarm system
  • but, pain can go wrong
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15
Q

what is pain and allodynia ?

A

pain - unpleasant sensory and emotional experience associated with actual or potential tissue damage,
but this definition does not account for the chronic pain which isnt associated with sensory input

allodynia - Pain due to a stimulus that does not normally provoke pain
feather causes pain

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16
Q

what is hyperalgesia ?

A

Increased pain from a stimulus that normally provokes pain

- dramatic response to scratch

17
Q

what is sensitization ?

A

Increased responsiveness of nociceptive neurons. Threshold changes

18
Q

what is central and peripheral pain?

A

-Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.
- peripheral
increased responsiveness
and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields.

19
Q

what is the flexion reflex ?

A

when we draw our limbs away from painful stimulis

20
Q

what is the Specificity and pattern theory ?

A

Pattern Theory - Nerves Conduct Info via Specific &Particular Pattern

Specificity Theory - Specific Nerve, Specific Brain Region

21
Q

what is the gate theory?

A

input can be done by large A-Beta fibers and small c-fibers

physical rubbing of area turns on inhibitory neuron reducing the activation and signal

22
Q

what is todays theory?

A

the pain matrix

brain interprets and assesses in context of environment mood and chemicals

23
Q

what is the neuromatrix?

A
  • signals are constantly received and assessed instantly
  • the body responds based on a variety of factors

-inputs include
+ Cognitive; memories and meaning
+ Sensory; cutaneous, visceral, msk input
+ Emotion; limbic system, homeostatic/stress systems

  • outputs include
    + pain perception
    + action patterns
    + stress regulation; cortisol, noradelaline, endorphins

the matrix does not say that cortical areas are reserved for pain, nor can patterns be corrected for pain free.

24
Q

is pain and individual and variable experience?

A

yes

25
Q

do individuals experience pain differently in terms of intesnity?

A

yes. Variable location and intensity

26
Q

what is the difference btwn the standard of practice in today’s PT culture vs. the proposed scheme?

A

Standard practice: address physical impairments with primary goal to reduce symps. emphasis on physical and less on psychological

-Psychologically Informed Practice
incorporating patient beliefs, attitudes, and emotional responses into patient management based on biophsychosocial models
- this is not Mental health practice.

27
Q

what is a red flag?

A

Signs of serious pathology

28
Q

what is an orange flag?

A

Psychiatric symptoms-depression, personality disorder

29
Q

what is a black flag?

A

Healthcare system limitation

•legislation, insurance limitations

30
Q

what is a blue flag?

A

Work-related factors

•belief that work is likely to cause injury or that supervisor isunsupportive

31
Q

What is a yellow flag?

A
  • Beliefs, appraisals, and judgments;pain catastrophizing
  • Emotional responses; worry, fears, anxiety
  • Pain behavior; Avoidance of activity due to pain
32
Q

what should we do with all patients

A

screen them all, and then follow up with a more in depth assessment in those who indicate

33
Q

how do you screen for depression?

A
  • “During the past month, have you often been bothered by feelingdown, depressed, or hopeless?” (Y/N)
  • “During the past month, have you often been bothered by littleinterest or pleasure in doing things?” (Y/N)
34
Q

Does the probability of severe depression decrease with one negative response?

A

yes, decreases from 20% to 5%

35
Q

Does the probability of severe depression decrease with 2 positive responses?

A

Probability of severe depression increases from 20% to 50% with 2 positive responses

  • if + on 2 questions, then consider PHQ-9
  • sensitive to change in depression severity over time
36
Q

what is the OMPQ12

A

-used for identifying work-injured patients at-risk of persistent musculoskeletal problems.

cut off scores: 
•0 paid days off work – <57 
•28 days or more off – >72 
•Poor recovery – > 72 )
•NRS severity of pain – >72
37
Q

What is the next step after screening?

A 
you should screen for multiple factors together.
Combinations of fear, anxiety, and catastrophizing 
-OMPQ12 
-STarT Back
- FABQ 
- TSK (tampa Scale Kinesiophobia)
- fear of activities 
-Pain Catastastrophizing Scale (PCS)
38
Q

what is the STarT Back?

A

•Developed for back pain to assist general practitioner refer for appropriate management. Sees who may need extra help

•Low risk
(overall score <4)
•suitable for primary care management?

  • Medium risk (overall score ≥ 4)
  • suitable for physical therapy?

•High risk (psychosocial subscale score≥ 4)
require a combination of physical and cognitive-behavioral approaches?

39
Q

what outcome should you use for Measuring fear across multiple anatomical locations?

A

Consider TSK or modified FABQ

-PCS loads separately in factor analysis and associated with pain intensity and disability

Pain science (4 decks)

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