lecture 9 - (Pain 4/4) Flashcards
what is the definition of natural prognosis?
the course a disease process or health condition can be expected to take without any intervention
what is the definition of clinical prognosis?
the course a disease process or health condition can be expected to take with a specific intervention
the anticipated long-term end point of a disease or health condition with/without any specific intervention is known as:
prognosis
a subtype of prognosis that represents the expected outcome of a specific intervention on this health status in this person at this time is:
Theragnosis/Theranosis
what is iatrogenic disability?
giving someone the sense they’re disabled by indicating they need treatment.
what are the three steps in a way to think about any clinical encounter:
a. assume - identify - perform
b. assess - predict - treat
c. identify - predict - begin
b. assess - predict - treat
what are the 3 important questions we ask in a prognosis?
- what are we trying to predict?
- what types of trajectories should we expect?
- who gets better, who doesn’t?
what are some examples of what recovery might mean to some people?
- absent or at least manageable symptoms
- participation in valued life roles
- having the physical capacity one ought to have (neighbour)
- feeling positive emotions
- autonomy and spontaneity
- re-establishing a satisfactory sense of self
What type of treatment recovery times do we expect pain typically whether mild, moderate or chronic
About 3 months for mild and moderate and no/little recovery from chronic pain (most recovery takes place in the first 12 weeks)
List 6 risk factors that cause higher likelihood of experiencing chronic pain (WAD)
List 7 factors that had no effect on the development of chronic pain (WAD)
Explain the 2 outcomes of the fear-avoidance model
1) No fear of pain, confront it and recover = positive outcomes
2) Catastrophize pain and develop fear of movement or injury and become avoidance hypervigilance which leads to disuse depression and disability which then recycles and causes more pain = poor outcomes
Why do physiotherapists fear the fear-avoidance model
Fear for physiotherapists of this model is that it is entirely psychological and not physical = hard for physiotherapists to treat
What is the main point of biomechanical theories?
There is a biological component for pain (eg. burn nerve to stop chronic pain for awhile)
What is the main point of stress-dysregulation theories?
Stress acts on a biological aspect which can cause pain (eg. dysregulation of endocrin system)
T or F: Varience of pain is inherited through genetics
T about 50%
Explain the fear-avoidance model in terms of 2 peoples experience of the same event
1) We all experience stress or elevated heart rate after an accident, but some people have a normal cortisol response and recovers while others have elevated cortisol response resulting in less likelihood to recover as easy
2)Model says that two people could experience the exact same accident, but based on their vulnerabilities and protections (diatheses), they can experience different recoveries (one having no recovery and the other completely recovering)
T or F: Most risk/prognosis tools are effective at identifying those with very high risk of poor outcomes compared to low risk outcomes
F, better at identifying those with low risk outcomes
Explain NDI tool
3 facts about tools for predicting chronic pain:
- Lean heavily on patient reports and cognitions/perceptions
- Good at discriminating high and low risk groups
- Rarely provide the why for an injury and treatment targets
T or F: Clinicians are ethically obligated to communicate prognosis and the likely accuracy of their predictions
T
