L25: Persistent Pain Part 2 Flashcards
Effective pain education can start in first consultation with around _____ minutes.
10-15
What are 5 clinically important treatments for persistent pain?
• Self-management strategies • Manual therapy • Diaphragmatic breathing/retraining movement behaviours • Neurodynamic exercises • Other exercises; stretches, motor control etc
What are the 3 aims of the desensitisation approach to treat the neuromatrix in chronic pain?
- Reduce the cognitive threat of the input
- Enhancing self-efficacy without aggravating symptoms
- Graded re-exposure to functional tasks
You need to get a ______ about what can be tolerated to make a start when Enhancing self-efficacy without aggravating symptoms.
baseline
What are 3 things to consider when determining how much input can be tolerated?
- The patient’s daily function and activities
- Previous levels of activity and exercise
- Aggravating and easing factors
What is the purpose of physical examination?
observe the patient’s current level of function and movements to highlight maladaptive behaviours
If movement/exercise is painful, you need to try to retrain at a tolerated level. What are 5 ways that it can be done?
- Breaking the task into smaller components
- Slower movements
- More supported positions
- Changing the context and environment of the task
- Eg. if they have issues with stress = quiet environment
- If the time of day matters = be aware
- Starting an exercise program or making changes to an existing one
How to enhance self-efficacy without aggravating symptoms when pain on flexion in standing?
Practice movements in less loaded positions
How to enhance self-efficacy without aggravating symptoms when bracing?
Practice movements in less loaded positions in quieter environments when relaxed and at tolerable time of day and able to practice breathing control
What are 3 ways to enhance self-efficacy without aggravating symptoms when pain on prolonged or repeated activities?
- Using exercise at time of day when symptoms are under control
- Breaking tasks down into manageable loads
- Consider ways to achieve more support with postures or loading
What 5 ways to enhance self-efficacy without aggravating symptoms in conjunction with managing other impairments?
- Build up tolerance alongside building on education
- Addressing flexibility or other fitness impairments
- Address strength impairments
- Consider motor control exercises for those appropriate
- Consider neurodynamic exercises if the patient is mechanosensitive
What are 5 ways in Graded functional re-exposure to potentially difficult tasks?
- Taking a painful task and teaching the patient how to gradually build up tolerance
- Breaking tasks down into smaller components.
- Encourage more and more activity in a graduated way
- Ensuring the patient understands that flare ups/set backs are normal and ok
- Being progressive and using long term thinking
It is therefore strongly recommended to use pain education with _____
exercise
Provide a patient with ______ easy exercises to start at home, or take their existing exercises and instruct them on the four to five you want them to focus on in persistent pain.
4-5;
The most common exercises are typically focused on large ______ movements and/or _____ in persistent pain.
range-of-motion; neurodynamics
The key is to introduce movement that is ______ and that also increases functional ability in persistent pain.
perceived as safe
They feel confident to do this independently
What is an example of program?
What is an example of a program progression?
Adding complexity (eg, reduce BOS, single leg)= exercises that are perceived as less safe (if master the other exercises)
What is the progression being more reactive?
More reactive –> jumping
- More effective as wont think about back as more complicated tasks
