Lecture 11

Question 1

Pain definition

Answer 1

unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

Question 2

Types of pain

Answer 2

Acute
Chronic
Referred

Question 3

Acute pain

Answer 3

usually short lived, associated with conditions such as tendinitis, muscle strains, contusions, surgery or ligament injuries

Question 4

Chronic pain

Answer 4

pain that persists after the noxious stimulus has been removed

Question 5

Referred pain

Answer 5

pain that is felt at a site distant from the location of injury or disease
viscera–> pain coming from organ

Question 6

Sources of pain

Answer 6

macrotrauma
microtrauma

Question 7

Macrotrauma

Answer 7

an immediately noticeable injury involving a sudden, direct, or indirect trauma

Question 8

Microtrauma

Answer 8

a long-standing or recurrent musculoskeletal problem that was not initiated by an acute injury

Question 9

You should assess these things with pain…

Answer 9

quality
intensity, location, pattern
psychological aspects
impact of pain on body

Question 10

McGill Pain Questionnaire

Answer 10

Longer than VAS (# scale)
intensity score
body diagram
assessment of pain relative to activities and pain patterns

Question 11

PROMIS

Answer 11

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

Question 12

PROMIS scoring

Answer 12

if physical function and self-efficacy have T-score of <42, considered significant
if PF and SE T-score >60, considered significant

Question 13

Acute pain and fear-avoidance

Answer 13

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

Question 14

Self-efficacy

Answer 14

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

Question 15

Self-confidence

Answer 15

broader and more stable trait concerning an individual’s perceptions of their overall capability

Question 16

If self-efficacy is high

Answer 16

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

Question 17

If self-efficacy is low

Answer 17

elevated pain-related fear is likely to lead to greater pain and disability

Question 18

Imaging and harm

Answer 18

increases perceived threat and fear associated with their impairment, causes improper healing techniques like extended bed rest

Question 19

With LBP, emphasize

Answer 19

anatomical understanding
pain science/perception
overall favorable prognosis of LBP
use coping strategies
improve activity not just pain

Question 20

What should PTs prescribe for LBP?

Answer 20

NOT imaging
moderate to high intensity exercise
progressive low intensity submaximal fitness and endurance
trunk coordination/functional movements

Question 21

Education and LBP

Answer 21

change in pain cognitions is associated with change in physical performance

education about pain neurophysiology changes pain cognitions and physical performance

Question 22

PTs goal concerning acute pain

Answer 22

STOP it from becoming chronic
therex interventions in the case of acute pain can help to stop the pain from developing to chronic pain

Question 23

pt expectations

Answer 23

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

Question 24

pt catastrophizing

Answer 24

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

Question 25

Improving adherence to exercise

Answer 25

graded exercise activity
supervised exercise sessions
refresher sessions
use of audio or video

Question 26

Therex interventions for acute pain phase

Answer 26

goal is to restore function at the injury site
prevention of injury at other sites
patient education about postures
ADL management

Question 27

Postural activities

Answer 27

quadruped spine flexion and extension
Alignment cues; neutral in sitting and standing