Lecture 8 - Pain (3 of 4)

Question 1

the Multimodal Assessment Model of Pain states that we cannot know someone else’s pain beyond:

Answer 1

1) Their ability to describe it
2) Our ability to interpret their description

Question 2

The Multimodal Assessment Model of Pain acknowledges that the patients ability to describe their pain is limited by what 4 factors:

Answer 2

1. Their ability to make sense of the experience
2. Their access to and use of language
3. Their prior experiences
4. Metaphors or analogy that are available to them

Question 3

Healthcare providers ability to interpret the patients narrative is influenced by what 3 factors

Answer 3

1. Personal and professional lenses and values
2. Ability to interpret and understand their choice of words or metaphors
3. Our own past experiences and need to make meaning

Question 4

2 useful characteristics of using clinical pain assessment tools

Answer 4

1. Bridge gap between patient experience and clinical understanding
2. Useful for shared decision making between client and provider when applied well

Question 5

What happens if clinical pain assessment tools are applied poorly?

Answer 5

They can reduce the rich experience of pain to a single number that becomes the focus of treatment

Question 6

5 reasons to evaluate pain

Answer 6

1. Aids in shared language around experience of pain
2. Help orient patient and provider of baseline of experience
3. Create patient-partnered milestones
4. Identify higher priority treatment targets
5. Use for screening, prognostic, theragnostic and discharge decision

Question 7

What is the numerical pain scale (NPRS)

Answer 7

A scale out of 11-points (0-10) that can be administered verbally/computer.
0 = no pain
10 = extreme pain

Question 8

4 important characteristics of NPRS to consider

Answer 8

1. Not an objective measure for pain
2. Shares a complex experience with another person
3. 2 point change is clinically meaningful
4. Difficult for person to rate pain to a single number

Question 9

Name 3 alternative tests to the NPRS

Answer 9

1. Visual Analog Scale
2. Wong Baker Faces Scale
3. Verbal Descriptor Scale

Question 10

Describe the radar plot.

Answer 10

Gives profile of pain rather than classification of pain.

Example in this image:
What does this mean: Primarily cognitive driver (pain is affecting mood/emotions), but also pain and emotional drivers as well

How to address/give options based on radar plot:
1) Provide resources (eg. Videos or books) to address cognitive aspect (demistify experience)
2) Result of mood (recommend to mental health professional)
3) For pain, can provide TENS or manual therapy)

Gave 3 options, now ask, where would patient like to start?

Question 11

What are the 3 classifications of pain?

Answer 11

1. Nociceptive
2. Nociplastic
3. Neuropathic

Question 12

What are the 7 pain profiles in the radar plot model?

Answer 12

1. Socioenvironmental
2. Sensorimotor Dysintegration
3. Nociceptive
4. Peripheral Neuropathic
5. Central Nociplastic
6. Emotional
7. Cognitive

Question 13

Patient Reported Outcomes

Answer 13

Information gathered directly from patient

Question 14

Clinician-observed/ Clinician-Administered Outcomes

Answer 14

Result of direct observation of patient by clinician

Question 15

Performance-based outcomes

Answer 15

Form of measurement/observation of actual performance of tasks or movements (either clinical or natural environment)

Question 16

5 characteristics of nociceptive

Answer 16

1. Predictable and consistent
2. Respond to NSAIDS/analgesics
3. Respond to thermal, electrophysical, manual and movement based therapies
4. Localized pain with predictable response to palpation
5. May or may not be accompanied with tissue damage (inflammation, malalignment, fracture)

Question 17

Name 6 characteristics of neuropathic pain

Answer 17

1. History consistent with damage to motor nerve:
   -Mechanical: crush, traction
   -Viral: Post-herpetic neuralgia
   -Endocrine: Diabetic neuropathy
   -Vascular: Ischemia, post-stroke pain
2. Allodynia (esp to light touch/mild cold)
3. Paroxysmal symptoms (itching, pricking, burning, cold)
4. +/- paresthesia
5. +/- related to consistent movement (eg. stretching out ulnar nerve makes it feel better)
6. Symptoms localized to known peripheral nerve distribution

Question 18

Name 6 characteristics of central nociplastic pain

Answer 18

1. Diffuse/widespread pain
2. Less predictable with movement or time of day
3. Not amendable by NSAIDS/analgesics but opioids, depressants, antiepileptics may help
4. Manual/movement/electrotherapeutic modalities less effective
5. Chronic
6. Not associated with ongoing peripheral tissue pathology

Question 19

Name 6 characteristics of Sensorimotor Dysintegration

Answer 19

1. Clumsiness
2. Poor joint position sense (proprioception
3. Poor two-point discrimination
4. Difficult identifying boundaries of injured body part in space
5. Body part appears smaller or larger than actually is
6. Unlikely response to NSAIDS/analgesics, but may respond to manual/mechanical/movement based interventions

Question 20

Name 6 factors of Cognitive pain

Answer 20

1. Catastrophizing
2. Fear of trying certain movements/fragility
3. Low expectations for improvement
4. Worry
5. Does not understand pain
6. Sense of hopelessness

Question 21

5 characteristics of emotional pain

Answer 21

1. Pain is associated with emotion or mood: depression, anxiety, distress
2. Psychopathology screening tools are postive
3. Not associated with movement, palpation, or other clinical tests
4. Poorly localized pain
5. May or may not have preceded MSK trauma

Question 22

Name 5 characteristics of socioenvironmental pain

Answer 22

1. Anything external that may affect experience or reporting of pain
2. Relationship to others
3. Housing, job security, food security
4. Prior experience of abuse or oppression
5. Medicolegal context