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PHTY2220 > L27: Persistent Pain Part 3 > Flashcards

L27: Persistent Pain Part 3 Flashcards

1
Q

What is the 3 steps in effective management of persistent pain?

A
  1. Reducing cognitive threat
  2. Enhancing self-efficacy (confidence)
  3. Gradual exposure
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2
Q

What are the clinical guidelines for persistent LBP?

A
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3
Q

What are the 3 assessment for the psychosocial levels (questionnaires)?

A
  1. START
  2. FABQ
  3. Orebro
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4
Q

When is TENS used for persistent LBP?

A

Ask patient –> have they done it before/ have they found it helpful?

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5
Q

What are 6 situations where formal MDT peristent pain programs?

A
  1. Offered through public and private hospitals and health centres 
  2. For patients with persistent pain where surgical management is not appropriate - usually those unable to return to full work duties
  3. “Pain relief” is not often the major objective. Functional restoration.
  4. An anatomical diagnosis and specific anatomical treatment is not pursued.
  5. Various combinations of exercise, education and cognitive behavioural therapy and may or may not include pharmacotherapy.
  6. Strong evidence for improving function, and moderate evidence in pain reduction, when compared with usual care
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6
Q

What are 7 members of the multi-disciplinary team?

A
  1. Specialist Pain Physician (assessment and review)
  2. Physiotherapist
  3. Co-ordinator (usually trained in pain management)
  4. Exercise physiologist
  5. Occupational therapist
  6. Psychologist
  7. Dietician- Often have co-morbidities
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7
Q

What does the MDT involved?

A

Group based education and support

Group based exercise, usually with six to eight participants.

Supervised by exercise physiologist or physio

Usually funded by WorkCover, Medicare, CTP insurance &private health funds

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8
Q

What is cognitive functional therapy?

A

A patient centred approach to management that targets the beliefs, fears and associated behaviours (both movement and lifestyle) of each individual

“Disabling back pain can change for the better with a different narrative and coping strategies.”

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9
Q

What is the major goal of cognitive functional therapy?

A

A major goal is leading the person to be mindful that pain is not a reflection of damage – but a process where the person is in a cycle of pain and disability, fuelled by a stressed and sensitive nervous system.

Changing patient pain beliefs –> reduce sensitivity of NS Redeveloping new habits and challenging existing ones.

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10
Q

What are the 5 characteristics of the management of non-specific chronic LBP?

A
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11
Q

What is the difference between cognitive functional therapy and manual therapy and exercise?

A
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12
Q

What are the 3 better short and long term outcomes of the CFT groups vs manual therapy and exercise?

A
  1. Pain
  2. Disability scores
  3. Patient satisfaction
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13
Q

What are 2 things that improvements depend on in cognitive functional therapy?

A
  1. Adopt biopsychosocial beliefs about their pain
    • Recognise that there are other factors that affect pain (eg. stress, work..etc) = better outcomes
  2. Feel they can independently self-manage their condition.
    • If educate the biopsychosocial model
    • Feel confident = better outcomes
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14
Q

How are the 2 groups of people who are most likely to benefit from cognitive functional therapy?

A
  1. Those who can adopt biopsychosocial beliefs
  2. Those that feel they can independently self-manage their condition.
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15
Q

Why are people who can adopt biopsychosocial beliefs most likely to benefit from cognitive functional therapy?

A

“Now I know there can be pain without major physical or structural problems”

Most participants entered the intervention with strong biomedical beliefs about the cause of their pain

A trusting relationship with the therapist facilitated effective communication and set the scene to challenge existing beliefs with a new explanatory model of pain

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16
Q

Why are people who feel they can independently self-manage their condition most likely to benefit from cognitive functional therapy?

A

Have skills and coping mechanisms The second key ingredient to successful outcome was achieving independent self-management of their pain.

“When I get the pain now, I’m able to check myself. I can unravel it myself”

Pain self-efficacy differentiated ‘large improvers’, those who reported a return to normality with renewed optimism for the future, and ‘small improvers’.

Day 1:

  • Self management is very important
  • Give tools and strategies
17
Q

What are the 7 roles of physiotherapy in cognitive functional therapy?

A
  1. Equipping patients with knowledge and skills for independent self-management.
    • Reassure and encourage patient = build confidence
  2. Challenging existing unhelpful beliefs through open discussion
    • What have you heard before? Give information
  3. Actively engaging the patient in learning based on personal experience and meaningful activities.
  4. Belief change alone is not sufficient to sustain improvements through CFT.
    • What have you heard before?
    • Give information
  5. Teaching or encouraging skills for independent self-management
    • Eg. different times of the day = more compliance
  6. Prescribing graduated exercise based on a ‘graded exposure’ model where the patient is exposed to previously pain provocative tasks, but in a relaxed and controlled manner
  7. Patients who cannot achieve independent self-management may need longer follow-up and/or refer to multidisciplinary care
18
Q

What are other treatment approaches for persistent LBP?

A
  • Surgery
  • Spinal cord stimulation (for neuropathic pain)
19
Q

Why is surgery a treatment for persistent LBP?

A
  • This is a good option for some patients
  • Surgery can help some patients to various degrees, but nearly half will not benefit
20
Q

Why is spinal cord stimulation for neuropathic pain (continually radicular pain) a treatment for persistent LBP?

A

More than half of all patients with chronic neuropathic pain experience sustained significant improvements.

  1. Provided through electrodes that are placed into the epidural space or through a surgical lead that is delivered via a laminotomy (quite invasive = needs laminotomy to put in)
  2. Predominantly in persistent neuropathic or radicular pain
  3. Requires patients to have trialled multidisciplinary pain clinic.
  4. Trialled first to assess benefit before implantation
21
Q

What are the 4 improvements of spinal cord stimulation for neuropathic pain (continually radicular pain) a treatment for persistent LBP?

A
  1. Provided through electrodes that are placed into the epidural space or through a surgical lead that is delivered via a laminotomy
  2. Predominantly in persistent neuropathic or radicular pain
  3. Requires patients to have trialled multidisciplinary pain clinic.
  4. Trialled first to assess benefit before implantation

PHTY2220 (31 decks)

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