LBP with Cognitive an Affective Tendencies & LBP with Generalized Pain Flashcards
What is the proposed underlying cause of LBP with Cognitive and Affective tendencies?
- An impairment in body function NOT associated with a specific pain mechanism, but the primary impairment in body function limitation activity and participation is related to YELLOW flags
- Specific pain mechanims may include acute or subacute low back pain and/or low-back related leg pain
- Low back pain does not follow the initial, mid-range or end-range movement/pain relations reflective of tissue stress, inflammation and irritability
What is the proposed underlying cause of LBP with Generalized Pain?
Generalized pain not consistent with other low back pain impairment-based classification
- Presence of depression, fear-avoidance beliefs, and/orpain catastrophizing
- Low back and/or back-related LE pain with symptoms duration of more than 3 months
- Movement impairments, such as hypomobility of thoracic, lumbopelvic, and hip joints with poor neuromuscular control and coordination of spinal motions
When conducting a Cervicothoracic Medical Screen, what are medical considerations we should look for?
Viscerogenic Conditions
- Neoplastic conditions
- Inflammatory or systemic disease
- Vascular Conditions - ex. Abdominal Aortic Aneurysm
Neuromusculoskeletal
- Spinal Fracture
- Back related infection
- Cauda Equina Syndrome
With LBP with Cognitive an Affective Tendencies & LBP with Generalized Pain, what are other conditions that should be considered?
- LBP with mobility deficit
- Low back with radiating pain
- LBP with movement coordination impairments
Sacroiliac Joint related conditions - LBP with movement coordination deficits
- LBP with mobility deficits
Subjective Examination
With LBP with Cognitive and Affective Tendencies, what system, structure, pain mechanism, and phases of healing are unique to this patient presentation?
- System: MSK; Psychosocial
- Structure: Ligaments, muscles, PNS
- Pain Mechanism: Anxiety and pain-related fear influence the pain perception. May include aspects of Nociceptive, Neuropathic, and Nociplastic pain
- Phase of Healing: Acute and Subacute stages (Muscle strain 2-4 weeks, ligament sprain 10-12 weeks)
With LBP with Generalized Pain, what system, structure, pain mechanism, and phases of healing are unique to this patient presentation?
- System: MSK; Psychosocial; Neurologic
- Structure: Ligaments, muscles, CNS, and PNS
- Pain Mechanism: Anxiety and pain-related fear influence the pain perception. May include aspects of Nociceptive, Neuropathic, and Nociplastic pain
- Phase of Healing: Chronic stage 3+ months
Subjective Exam
What are some common subjective reports you may hear with a patient with LBP with Cognitive and Affective tendencies?
- Hx of acute or subacute trauma or injury
- Back pain with or without somatic referred pain in the LE
- High pain and disability scores common
- Concurrent Sx or diagnosis of anxiety or depression
- Variable agg/ease factors and 24 hr pain behavior based on the dominate pain mechanism and yellow flags
Subjective Exam
What are some common subjective reports you may hear with a patient with LBP with Generalized Pain?
- Hx of chronic trauma or injury
- Back pain with or without referred pain in the LE
- Constant and unremitting pain with night pain and disturbed sleep
- Hx of depression, anxiety, fear avoidance beliefs, pain catastrophizing
- Variable agg/ease factors and widespread distribution and disproportionate pain experience
Subjective Exam
What are common beliefs that patients with LBP with Cognitive and Affective Tendencies & LBP with Generalize pain have?
- Pain is harmful and disabling, resulting in fear of movement and guarding
- Pain must completely resolve before returning to activity
- Work/activity will increase pain
- Pain is uncontrollable
- The worst will always happen (catastrophizing)
- Rehab will not likely help
What are common behaviors that patients with LBP with Cognitive and Affective Tendencies & LBP with Generalize pain have?
- They may have extended rest
- They may reduce or avoid ADLs
- They may Report extremly high pain intensity
- They may Rely excessively on braces, aids, etc
- May have poor sleep quality
- May have increase in alcohol, substance, or tobacco use
Objective Exam
After conducting a systems review to those patients with LBP with Cognitive and Affective Tendencies & LBP with Generalize pain, you would do an Advanced Sensory Examination. What takes place in this examination?
- Pressure Algometry: may have reduced pain threshold
- Ice-Pain test: May hace cold hyperalgesia
- SLR neurodynamic testing
- Temporal Summation: may have increased pain sensitivity
- 2-point discrimination
- Localization
- Brush-evoked sensitivity for allodynia
Objective Exam
With patients with LBP with Generalize pain, we must consider a population of people with Excessive Force Closure of the SI Joint. What is Excessive Force Closure?
- This is associated with excessive, abnormal and sustained loading of SIJ structures.
-Local and Global muscles activation - May have localized pain at SIJ, surrounding ligaments and muscle tissues
- May have habitual erect lordotic lumbopelvic posture and high level of co-contraction of regional muscles
- May be preoccupied with concerns of being “unstable” or “displaced”, have high levels of stress and anxiety
Objective Exam
With patients with LBP with Generalize pain, we must consider a population of people with Excessive Force Closure of the SI Joint. What are some SI provocation Test that the patient may be (+) with?
- (+) Hip thrust, SI Compression and Distraction
- (-) Active Straight Leg Raise and Manual compression or SI Belt make Sx worse
What are the Prognostic Factors for LBP with Generalized Pain?
- Presence of Sx below the knee
- Psychological distress or depression
- Fear of pain, movement and reinjury or low expectations of recovery
- pain of high intensity
- A passive coping lifestyle
- Work-related parameters
What are the Factors that may Impact Prognosis of LBP with Cognitive and Affective Tendencies & LBP with Generalize pain?
- High P! intensity (NPRS Less than or = to 6/10)
- High Self-reported disability (ODI >/= 34% - Moderate)
- High Pain Catastrophizing (PCS >/= 30)
- High PTSD Sx (IES >/33)
- High Central Sensitization Inventory (CSI >40/100)
- High Fear Avoidance beliefes Questionnaire - Work (FABQw >34)
- High Fear Avoidance beliefes Questionnaire - Physical Activity (FABQpa >15)
- High Tampa Scale of Kinesiophobia-11 (TSK-11> 37/44)
