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Modalities > Modalities Ch. 8 > Flashcards

Modalities Ch. 8 Flashcards

1
Q

what is pain?

A

subjective
#1 reason an athlete seeks tx
physiological
modulates response to a pain inducing stimulus

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2
Q

types of subjective pain

A

emotional
psychological
social

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3
Q

why is pain physiological

A

it is associated w/ tissue damage

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4
Q

cause and effect types of pain

A

simple pain
response aimed at protecting and healing
simple pain can become chronic pain (> 3 months)

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5
Q

simple pain

A

acute pain
tissue damage
most sports-related pain
alarm system alerts brain to actual or potential tissue damage

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6
Q

how does pain protect and heal the body?

A

it signals the brain that there is something wrong

plays a role in initiating the healing processes

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7
Q

how can simple pain become chronic?

-% of pop. that suffers from chronic pain

A

untreated
incorrect treatment
20% suffer

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8
Q

consequences of chronic pain

A 
depression
decreased activity/disability
atrophy
loss of skill
anxiety
circulatory deficiency
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9
Q

how is pain described?

A

subjectively
-burning, sharp, achey, deep
we try to make it objective
-1-10 pain scales

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10
Q

nociception

A

ability to feel pain

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11
Q

nociceptors

A

specialized nerve endings that respond to stimulus - mechanoreceptors, thermoreceptors, chemoreceptors

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12
Q

how are nociceptors classified

A

by location

  • cutaneous
  • somatic
  • visceral
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13
Q

which nociceptors are most common?

A 
mechanical nococeptors (a-delta, force)
polymodal nociceptors (C, heat, mechanical pressure)
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14
Q

function of A-delta fibers

A

pain transmission
crude touch
pressure
temperature

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15
Q

function of C-fibers

A

pain
touch
pressure
temperature

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16
Q

nociception vs. pain

A 
nociception
-specific neurophysiological activity
pain
-interpretation of nociception
--subjective and emotional
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17
Q

impacts on pain

A

past pain experience
general life stress
heredity
personality differences

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18
Q

common noxious stimuli

A

mechanical - pressure directly on a nerve (swelling, muscle spasm)
thermal
electrical
chemical - mediators that are present when injured, bradykinin

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19
Q

pathway of pain

A

slam hand in car door
pain signal - chemicals released
chemicals signal receptor to generate a signal
signal travels up the arm on first-order neurons
transmit to the dorsal horn of the spinal cord
signals relayed to a second order neuron
neurons transmit the signal up the spinal cord
received at the thalamus
pain signal transmitted to the cerebral cortex by the third order neuron
pain signal is processed

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20
Q

pain terminology

A

perception threshold
-when it starts to hurt
tolerance threshold
-when someone acts on the pain

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21
Q

Specific Theory of Pain

A

specific nociceptors
specific nerve pathways
specific sensation

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22
Q

Pattern Theory of Pain

A

no existence of specific pain receptors
slow-conducting nerve fibers carry pain
fast-acting nerve fibers carry other sensations
normally, the fast-conduction fibers override the pain
under pathological conditions, the intensity of the stimulation in the slow system becomes much greater and dominates the fast system, resulting in pain

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23
Q

Pattern Theory of Pain flaw

A

too general - doesn’t account for receptor specialization

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24
Q

Gate Control Theory

A

specificity + pattern theory
operates at spinal level
proposes a gate mechanism
central control

25
Q

gate mechanism

A

-pain and other sensory stimuli travel along both large and small nerve fibers
-both stimulate T-cells which pass onto brain
action system includes all responses to the pain
inhibitory mechanism located in the substantia gelatinosa
SG inhibits the T-cell
differential stimulation of SG cells

26
Q

what types of pain do the large and small fibers carry?

A

large: sharp, stinging
small: dull, aching

27
Q

how do large and small fibers stimulate the SG?

A

large: facilitates SG
small: inhibits SG

28
Q

Gate Control Theory problems

A

does not account for phantom limb pain

cannot explain influence of drugs on pain

29
Q

types of pain relieving drugs

A 
morphine
naloxone
enkephalin
endorphin
serotonin
30
Q

morphine function

A

blocks pain

  • fills neurotransmitter sites
  • neorutransmitter blocked
31
Q

naloxene function

A

morphine antidote: reverses effects

32
Q

enkephalin

A
  • mixture of two peptides
  • similar in shape and similar analgesic properties as morphine
  • found in brain, spinal cord, gut
  • half-life very short thus operates at spinal cord level
  • block the gate by interfering w/ A-delta and C fiber signal transmission to T-cells
  • released through non-painful sensory stimulus
  • -sensory TENS, gentle massage
33
Q

endorphin

  • similar to…
  • where is it produced?
  • half-life
  • where does it act?
  • how does it work?
  • how are they released?
A

endogenous molecule
similar to morphine
produced in pituitary and circulated through body
half-life = four hours
acts in several areas of CNS (including dorsal horn)
inhibits pain signal transmissions and decreases chemical irritants in CNS
may be released by acupuncture and intense exercise

34
Q

serotonin

A

biochemical messenger and regulator
found primarily in CNS, GI tract, and blood platelets
mediates several physiological function, including neurotransmission
may influence pain perception via descending tract (brain to spinal cord), block signals from peripheral nociceptors

35
Q

dopamine

A

neurotransmitter in extrapyramidal system of brain
important in regulating movement
may also be used to synthesize norepinephrine and epinephrin
affects brain processes ___________

36
Q

opoids

A

endogenous opiates
term used to denote body’s internal pain killers such as enkephalin, endorphin, serotonin, and dopamine
bind to opiate receptors in the brain
operate in different parts of nervous system
effective for varying lengths of time

37
Q

levels of pain control

A

level I: ascending influence pain control
level II: descending influence pain control
level III: beta-endorphin-mediated pain

38
Q

level I: ascending influence pain control

A

traditional gate control pain relief theory
gating mechanism induce pain relief
TENS, massage, cryotherapy

39
Q

level II: descending influence pain control

A

pain relief occurs in higher brain centers
release of enkephalin modulates pain
possible explanation for C-fiber activation relieving pain
ex.: acupuncture or noxious TENS

40
Q

level III: beta-endorphin-mediated pain

A

prolonged stimulation of A-delta fibers
triggers the release of beta endorphins
longer term pain relief due to the 4hr half-life of endorphins

41
Q

dimension of pain

A 
social
emotional
psychological
physiological
therapy is an art
42
Q

function of social, emotional, and psychological dimensions of pain

A

reasons why therapy doesn’t work

affect the rate of therapy

43
Q

how to make a patient the owner of their pain

A 
communication
distraction
education
use it as a positive
responsibility
-pain meds.
-treatment
44
Q

when do we ignore pain

A 
minimal
chronic
sore vs. pain
denial
inconvenient/annoying
conditioning
45
Q

when do we listen to pain

A 
when it is significant
interferes with everyday life
visceral
familiar
-past experience
46
Q

what does it mean to respect pain

A 
understand when it needs attention
knowing when to stop/continue
-past experience
-type of pain
-understanding consequences
47
Q

Dehne’s Spinal Adaptation Syndorme

A

afferent nociceptive impulses from traumatized tissue alter the integration of central nervous excitation at the spinal cord
-decreased response to volitional stimuli
-increased response to otherwise subliminal peripheral stresses
results in involuntary muscle action
alters repair
responds adversely to addition stress, favorably to reestablishing central control
nociceptive impulses from traumatized tissue inhibit motor function and tissue repair
voluntary activity can reestablish CNS control and prevent this inhibition
prolonged inactivity after injury will lead to neural inhibition that may become permanent

48
Q

resetting central control

A

not enough to just get rid of the pain sensation
must also get rid of the effects of the pain
-reset the system

49
Q

Chicago Plane Analogy

A

a tire blowout occurs during takeoff
the runway is shut down so the damaged plane and debris can be romoved
the runway reopens (pain removed)
however, thousands of passengers are stranded because of canceled flights (Chicago and elsewhere)
meetings must be rescheduled, which takes time after the reopening of the airport

50
Q

resetting central control after injury

A

progression exercise

51
Q

source of athletic injury pain

A 
nociceptor pain
-cause of most sports injury pain
relay impulse to spinal cord
nociceptor is stimulated by
-injured tissue (mediator release)
-edema pressure
-stretching injured tissue
-otherwise normal activity in a tissue that is sensitized from disuse after injury
52
Q

source of athletic injury pain

A

neuropathic pain
-complex, chronic pain state accompanied by tissue damage to nerve fibers
occurs due to
-acute nerve damage
-disuse following injury
-surgery that involves neural tissue
-condition that cause nerves to become dysfunctional

53
Q

sources of athletic injury pain

A 
learned pain
-learned, or conditioned, response
--"pain memories"
-\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
idiopathic pain
-unknown origin
--no identifiable pathology
54
Q

placebo

  • latin
  • ___% receive relief
A 
latin-I shall please
mock intervention
patient belief
psychological effects
35% of postoperative, diabetes, or chronic headache patients receive relief from placebos
55
Q

placebos

-why?

A 
power of the mind
believing something will work may increase effects
-educate patients
-be positive
-set goals
56
Q

pain relief types

A

direct

indirect

57
Q

direct

A

get rid of the pain source

58
Q

indirect

A

treating the pain but not the source

59
Q

tools for relieving pain

A 
immobilization
therapeutic exercise
counter-irritants
thermotherapy
electrotherapy
cryotherapy
psychological tools

Modalities (16 decks)

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