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Worst EXAM 2 > Living with Chronic Pain > Flashcards

Living with Chronic Pain Flashcards

1
Q

Talk briefly about the tissue approach to pain

A

Assumption that pain is a result of physical issue with the structures of body
Relies on biomechanical models and treatments

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2
Q

What are some potential issues with the tissue approach to pain? (4)

A

Oversimplifies issues of chronic pain by not taking into account pain neuromatrix

No consideration of sensitization

May increase patient fears and anxiety

Limited efficacy with chronic pain patients

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3
Q

What does the neuromatrix approach to pain entail?

A

Deemphasizes traditional tissue based anatomical models

Incorporates biopsychosocial aspects

More complete picture of the neurophysiology of pain, including sensitization

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4
Q

How can understanding the neuromatrix approach to pain help our patients?

A

Understanding this concept can help people with chronic pain function, have decreased fear and have increased movement

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5
Q

What is another name for neuromatrix?

A

Neuroscience Education

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6
Q

What are two benefits of neuroscience education? (2)

A

Louw, et al demonstrated decreased use of healthcare with neuroscience education before surgery

Similar pain after surgery, but with higher overall patient satisfaction

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7
Q

What would be the result of us providing appropriate neuroscience education to our patients? (2)

A

This suggests that helping patients properly understand pain may help them function better and be more satisfied with the care they receive

This may not alleviate their pain, but it can help them function better and avoid being disabled by their pain

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8
Q

What are the hallmarks of sensorimotor system reorganization in chronic pain patients? (3)

A

Patients with chronic pain have reorganization of sensorimotor system:

  • Central sensitization
  • CLBP patients have decreased cortical spinal drive to lumbar spinal muscles
  • Delay in activation of TrA has been correlated to amount of reorganization in brain
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9
Q

What are the consequences of sensory- motor system reorganization?

A

These changes lead to decreased performance and increased symptoms, which in turn can lead to more reorganization

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10
Q

How could we reverse the effects of sensorimotor system reorganization?

A

By resetting the system through Motor Rehabilitation?

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11
Q

What is the goal for Motor Rehabilitation?

A

Goal: Re-establish normal motor function and decrease pain by maximizing positive neuroplasticity

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12
Q

How do we facilitate neuroplasticy?

A

Best accomplished through motor skill training

  • not just simple mindless exercise
  • in order to facilitate neuroplasticy, learning must occur
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13
Q

What are the two stages of motor learning and the rough time frame for each?

A

Generally occurs in 2 stages:
Fast, early stage (hours)
Slow, later stage (weeks)

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14
Q

What are the steps we should follow in order to optimize motor rehab? (4)

A
  1. Focus on skilled training, not just strength training
  2. Motor skill training should be performed in ways that minimizes pain
  3. Encourage Cognitive effort
  4. Quality over quantity
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15
Q

Explain why we have to focus on skill training and not just strength training for motor learning to occur?

A

Targeting a specific component of movement requires greater focus and promotes increased neuroplastic changes.

Research suggests that adding strength training to motor skill training does not promote greater changes in the primary motor cortex than just doing motor skill training.

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16
Q

Why should we choose activities and parameters that minimize pain while we try to promote motor learning?

A

Pain can hinder cortical neuroplastic changes associated with novel motor skill acquisition

This will impact load, frequency, type of activity, etc

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17
Q

How do we encourage Cognitive Effort during Motor Rehab?

A

Most complex tasks require more focus, and stimulate more cortical changes

Slowly increase the complexity of novel skill tasks

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18
Q

Why is quality more important than quantity in motor learning and motor rehab?

A

Most cortical changes begin occurring quickly, with research showing no difference with increased repetitions

Quality of movement very important for proper motor learning

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19
Q

What would you recommend for chronic pain patients: rest or physical act.?

A

Physical activity and exercise has been shown to be more effective than the old approach of inactivity and rest.
especially when individualized

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20
Q

What is kinesiophobia?

A

fear of movement

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21
Q

What is the best exercise for chronic pain patients?

A

Not one specific exercise has been shown to be “best”

Advantages of each especially when individualized

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22
Q

What is the multidimensional definition of exercise?

3 components of exercise
(how it is manifested?)
(what is the purpose?)

A

Biochemical, social and physical activity

Manifested in a variety of forms

With the purpose of training or developing the body to promote physical health

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23
Q

What are some general benefits of aerobic exercise?

A

Releases endogenous opioids, beta-endorphins
Blocks pain and induces relaxation

Other:

  • Weight loss and less load on the joints
  • Strengthen core muscles which support bones and cartilages keeping the joints intact

Deconditioning = worsens the pain

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24
Q

Name some significant short and long term benefits of aerobic exercise in fibro and chronic pain patients?

A

Immediate ↓ in anxiety and/or depression

↓Pain

↑ cardiovascular fitness and well-being

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25
What is the optimal intensity and duration for aerobic exercise, that was found to have the largest/moderate effect over induced pain in healthy?
Large effect -  75% VO2max , >10 min Moderate effect - 50% VO2max , 30 min
26
What is the optimal intensity and duration for isometrics, that was found to have the largest effect over induced pain in healthy?
Greatest effect: low intensity, long duration (≅5 - 9 min, until task failure)
27
Was the hypoalgesic effect isolated to the contracting muscles?
Not isolated to the contracting muscle It spread in the muscles from the vicinity.
28
How long did the hypoalgesic effect last after isometrics?
Dissipated after: 10 min in the noncontracting muscles, 30 min in the contracting muscles
29
How long did the hypoalgesic effect last after dynamic resistance?
1-5 min post -still large effect | 15 min post the effect was small
30
How long did the hypoalgesic effect last in chronic pain patients?
up to 30 min?
31
True/False | Effects of exercise over induced pain are similar in chronic pain patients with the healthy population.
True
32
Chronic Pain patients: | What is the optimal intensity for aerobic exercise?
Large-to-moderate effect at moderate or preferred intensity (FMS)
33
Chronic Pain patients: | What is the optimal intensity for isometrics?
Even 10% effort had large Hypoalgesic effect.
34
What are the main points we should remember about exercise in chronic pain patients?
Low to moderate intensity produces EIH (exercise induced hypoalgesia) -Moderate to vigorous produces moderate HYPERALGESIC effect
35
Shortly define and present the benefits of graded exposure
Positive behavioral and cognitive therapy to confront, prescribe and dose functional activities Make a list of most feared to least feared activities or situations - Exposure begins with the least feared activity - Address the feared consequences, incorrect appraisals and beliefs - ↓Anxiety and ↑ participation
36
What are the effects of graded exercise in acute and sub-acute population?
Associated with ↓ in catastrophizing and depression Changes self-efficacy beliefs, reduces perceived disability and long term use of treatment   Improves work absentee outcomes
37
What does literature say about core strengthening in CLBP versus acute back pain?
Core lumbar strengthening and spine stabilization exercises beneficial in CLBP, but not in acute LBP Strengthening of multifidi and TrA are believed to improve CLBP, but lacks research for specific and most effective exercises
38
What are the benefits of McKenzie approach when compared with dynamic stretching exercises?
McKenzie approach compared with dynamic stretching exercises (260 patients) Slightly more successful at improving level of function at 2 month follow-up Effects not maintained at the longer follow-up
39
Name three exercise practices that improve flexibility, coordination and relaxation?
Yoga Pilates based exercises Tai-Chi
40
How is Yoga, Pilates,Tai-Chi different from regular exercise? (These are aspects that would promote motor learning and motor rehab)
Incorporate stretching and flexibility while engaging the participant in a “mind–body” awareness of physical and psychological relaxation or concentration.
41
What are the benefits of yoga in chronic pain patients?
Greater and longer lasting improvements in patients with CLBP than simply educational intervention Significant ↓in pain, disability, pain medication use at 3-month follow-up Not superior to conventional exercise treatment program
42
What are the benefits of pilates in chronic pain patients?
Equally effective as usual care or other exercise in ↓ pain and disability Results not conclusive due to a small # of studies and short follow-up
43
What are the benefits of Tai-Chi in chronic pain patients?
Small and short-term positive effect on both pain and function Unclear impact on quality-of-life due to poor design studies and small samples
44
Name 4 general components of pain management programs
Relaxation Exercise Rational use of medication Specialist - patient communication
45
Define self-management as related to chronic pain
Self management- The ability to manage the symptoms, treatment, physical & psychological consequences and lifestyle changes inherent in living with a chronic condition
46
What are the two theories that explain self-management?
Social Cognitive Theory Self Efficacy Theory (continuous care for patients with complex health problems)
47
What does the Social Cognitive Theory imply?
An individual’s environment, cognition, and behavior all interact to determine how he/she functions
48
What does Self Efficacy Theory imply?
Belief in yourself to successfully perform a task or reach a certain goal (It is an extension of social cognitive theory)
49
What are some ways we as PT’s can help a patient develop a self-management program? (8)
1. Self-efficacy building 2. Self monitoring 3. Goal setting 4. Action planning 5. Decision making 6. Problem solving 7. Self-tailoring 8. Partnership between the views of patients & health professionals
50
Define resilience
Resilience- ability to cope with adversity | Maintaining a “stable equilibrium” over a long term
51
What is higher resilience associated with? (4)
Active pain coping strategies Better long-term functional recovery Positive mood Higher activity levels
52
what is the role of social support in resilience level?
People with high social supports tend to have: | Better mental health & superior levels of resilience
53
True/False People who have high resilience are more likely to be working despite their pain
True
54
Define self-reliance in the context of Chronic Pain management.
Self-reliance- utilizing your own resources instead of relying on the help of others Developing strategies of self-care rather than depending on: - Health professionals - Medications - Health system
55
Which is the preferred approach in chronic pain treatment Multidisciplinary or Interdisciplinary?
Interdisciplinary
56
What are the characteristics and advantages of the Multidisciplinary approach? (was this supposed to say interdisciplinary?)
Incorporates exercise Team approach- common goals. More effective than non-interdisciplinary rehabilitation for  chronic and sub-acute low back pain - More effective than traditional models in treating patients with multiple chronic conditions
57
Name 2 evidence-based models of Integrated Healthcare (interdisciplinary)
1. The Integrated Framework for Living Well with Chronic Illness 2. The Chronic Care Model
58
What are the advantages of Integrated Healthcare Model?
Multiple services at one site in single clinic visit, and from a team of collaborative providers. Holistic approach - Reduces duplication of services, cut costs, and improve patient outcomes.
59
Briefly describe the components, results and members involved in the Integrated Framework for Living Well with Chronic Illness.
Examines factors that determine a person’s: Health Genes Biology Behavior coping response Peers and family Sociocultural factors, and the environment Influence an individual’s lifetime symptom experience and illness-wellness trajectory. These also affect caregivers, the community, and society.
60
What is the Chronic Care Model and what is its main advantage?
A collaborative approach to chronic disease management. Shown to enhances interactions between health care teams and patients to improve outcomes. Six (6) interventions to improve communication
61
What are the six major components in the Chronic Care Model?
The Community: public and private resources and policies; community advocacy for individuals with chronic pain The Health System: how healthcare is organized, including its payment structures; Self-Management Support: education, tools, motivational techniques, patient empowerment Delivery System Design: the structure of the provider organization (hospital system, clinic, doctor’s office) and the organization of patient encounters; Decision Support: clinicians can access and adhere to evidence-based guidelines for care; to support clinical decision making Clinical Information Systems: computerized information, medical records, decision support tools, reminders, etc to track data and trends
62
Chronic Care Model: The Community (describe it)
The Community: public and private resources and policies; community advocacy for individuals with chronic pain
63
Chronic Care Model: The Health System (describe it)
The Health System: how healthcare is organized, including its payment structures;
64
Chronic Care Model: Self-Management Support (describe it) - (4)
Self-Management Support: education, tools, motivational techniques, patient empowerment
65
Chronic Care Model: Delivery System Design (describe it)
Delivery System Design: the structure of the provider organization (hospital system, clinic, doctor’s office) and the organization of patient encounters;
66
Chronic Care Model: Decision Support (describe it)
Decision Support: clinicians can access and adhere to evidence-based guidelines for care; to support clinical decision making
67
Chronic Care Model: Clinical Information System (describe it)
Clinical Information Systems: computerized information, medical records, decision support tools, reminders, etc to track data and trends

Worst EXAM 2 (4 decks)

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