Lecture 11 Flashcards
Pain definition
unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
Types of pain
Acute
Chronic
Referred
Acute pain
usually short lived, associated with conditions such as tendinitis, muscle strains, contusions, surgery or ligament injuries
Chronic pain
pain that persists after the noxious stimulus has been removed
Referred pain
pain that is felt at a site distant from the location of injury or disease
viscera–> pain coming from organ
Sources of pain
macrotrauma
microtrauma
Macrotrauma
an immediately noticeable injury involving a sudden, direct, or indirect trauma
Microtrauma
a long-standing or recurrent musculoskeletal problem that was not initiated by an acute injury
You should assess these things with pain…
quality
intensity, location, pattern
psychological aspects
impact of pain on body
McGill Pain Questionnaire
Longer than VAS (# scale)
intensity score
body diagram
assessment of pain relative to activities and pain patterns
PROMIS
patient reported outcomes measurement information system
assess patient problems in multiple generic health domains
assess global health vs disease specific effects
low floor and ceiling affects, adjusts scale to individual
areas of assessment: pain interference, physical function, fatigue, self-efficacy, depression
PROMIS scoring
if physical function and self-efficacy have T-score of <42, considered significant
if PF and SE T-score >60, considered significant
Acute pain and fear-avoidance
pain can be perceived as non-threatening or threatening
impacts how the pt heals and engages in daily activities
good perception of pain allows pt to have a functional recovery
Self-efficacy
belief in one’s capabilities to organize and execute the courses of action required to produce given attainments
belief about their abilities, not the same as confidence
low self-efficacy can cause avoidance with healing
Self-confidence
broader and more stable trait concerning an individual’s perceptions of their overall capability
If self-efficacy is high
elevated pain-related fear might not lead to greater pain and disability
found to mediate the relation between pain-related fear and pain intensity and between pain-related fear and disability
If self-efficacy is low
elevated pain-related fear is likely to lead to greater pain and disability
Imaging and harm
increases perceived threat and fear associated with their impairment, causes improper healing techniques like extended bed rest
With LBP, emphasize
anatomical understanding
pain science/perception
overall favorable prognosis of LBP
use coping strategies
improve activity not just pain
What should PTs prescribe for LBP?
NOT imaging
moderate to high intensity exercise
progressive low intensity submaximal fitness and endurance
trunk coordination/functional movements
Education and LBP
change in pain cognitions is associated with change in physical performance
education about pain neurophysiology changes pain cognitions and physical performance
PTs goal concerning acute pain
STOP it from becoming chronic
therex interventions in the case of acute pain can help to stop the pain from developing to chronic pain
pt expectations
patient can have unrealistic expectations of when they will heal or how their pain will feel
strategies: be realistic with goals but encourage participation in decision making
pt catastrophizing
hinders recovery, makes treatment more difficult, increases risk of developing persistent pain and disability b/c of avoidance, fear, isolation
strategies: promote physical and social activity. begin with graded activity that establishes self-efficacy and success
Improving adherence to exercise
graded exercise activity
supervised exercise sessions
refresher sessions
use of audio or video
Therex interventions for acute pain phase
goal is to restore function at the injury site
prevention of injury at other sites
patient education about postures
ADL management
Postural activities
quadruped spine flexion and extension
Alignment cues; neutral in sitting and standing
