Living with Chronic Pain Flashcards
Talk briefly about the tissue approach to pain
Assumption that pain is a result of physical issue with the structures of body
Relies on biomechanical models and treatments
What are some potential issues with the tissue approach to pain? (4)
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
What does the neuromatrix approach to pain entail?
Deemphasizes traditional tissue based anatomical models
Incorporates biopsychosocial aspects
More complete picture of the neurophysiology of pain, including sensitization
How can understanding the neuromatrix approach to pain help our patients?
Understanding this concept can help people with chronic pain function, have decreased fear and have increased movement
What is another name for neuromatrix?
Neuroscience Education
What are two benefits of neuroscience education? (2)
Louw, et al demonstrated decreased use of healthcare with neuroscience education before surgery
Similar pain after surgery, but with higher overall patient satisfaction
What would be the result of us providing appropriate neuroscience education to our patients? (2)
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
What are the hallmarks of sensorimotor system reorganization in chronic pain patients? (3)
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
What are the consequences of sensory- motor system reorganization?
These changes lead to decreased performance and increased symptoms, which in turn can lead to more reorganization
How could we reverse the effects of sensorimotor system reorganization?
By resetting the system through Motor Rehabilitation?
What is the goal for Motor Rehabilitation?
Goal: Re-establish normal motor function and decrease pain by maximizing positive neuroplasticity
How do we facilitate neuroplasticy?
Best accomplished through motor skill training
- not just simple mindless exercise
- in order to facilitate neuroplasticy, learning must occur
What are the two stages of motor learning and the rough time frame for each?
Generally occurs in 2 stages:
Fast, early stage (hours)
Slow, later stage (weeks)
What are the steps we should follow in order to optimize motor rehab? (4)
- Focus on skilled training, not just strength training
- Motor skill training should be performed in ways that minimizes pain
- Encourage Cognitive effort
- Quality over quantity
Explain why we have to focus on skill training and not just strength training for motor learning to occur?
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.
Why should we choose activities and parameters that minimize pain while we try to promote motor learning?
Pain can hinder cortical neuroplastic changes associated with novel motor skill acquisition
This will impact load, frequency, type of activity, etc
How do we encourage Cognitive Effort during Motor Rehab?
Most complex tasks require more focus, and stimulate more cortical changes
Slowly increase the complexity of novel skill tasks
Why is quality more important than quantity in motor learning and motor rehab?
Most cortical changes begin occurring quickly, with research showing no difference with increased repetitions
Quality of movement very important for proper motor learning
What would you recommend for chronic pain patients: rest or physical act.?
Physical activity and exercise has been shown to be more effective than the old approach of inactivity and rest.
especially when individualized
What is kinesiophobia?
fear of movement
What is the best exercise for chronic pain patients?
Not one specific exercise has been shown to be “best”
Advantages of each especially when individualized
What is the multidimensional definition of exercise?
3 components of exercise
(how it is manifested?)
(what is the purpose?)
Biochemical, social and physical activity
Manifested in a variety of forms
With the purpose of training or developing the body to promote physical health
What are some general benefits of aerobic exercise?
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
Name some significant short and long term benefits of aerobic exercise in fibro and chronic pain patients?
Immediate ↓ in anxiety and/or depression
↓Pain
↑ cardiovascular fitness and well-being
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
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)
