Nijs article

Question 1

What is the 2011 article by Nijs et al about?

Answer 1

Practical guidelines for explaining central sensitization to patients with chronic unexplained msk pain.

Question 2

When is pain physiology education indicated according to Nijs 2011?

Answer 2

1) when central sensitization dominates clinical pictures. 2) maladaptive illness perceptions are present.

Question 3

What are 2 ways we can help change someone’s chronic pain condition?

Answer 3

face to face education about pain physiology and written materials to take home.

Question 4

What are examples of the chronic conditions that may benefit from pain physiology education?

Answer 4

chronic LBP, chronic whiplash, fibromyalgia, chronic fatigue syndrome.

Question 5

in the 1st session, what 2 types of pain are important to differentiate for the pt?

Answer 5

acute nociceptive pain vs. chronic pain.

Question 6

What can the 2nd session be used for?

Answer 6

correct misunderstandings & facilitate change from knowledge of pain to adaptive coping in daily life.

Question 7

What are the basic neurological changes that characterize central sensitization?

Answer 7

decrease in ability of descending pain inhibition. And increase in ascending and descending pain facilitatory pathways.

Question 8

What areas of the brain are overly active in the altered pain neuromatrix?

Answer 8

the normal acute pain centers: insula, anterior cingulate cortex, and prefrontal cortex (not primary or secondary somatosensory cortex) and areas of brain not normally active in acute pain: various brain stem nuclei, dorsolateral frontal cortex, parietal associated cortex.

Question 9

What is “cognitive emotional sensitization”?

Answer 9

Phenomena of forebrain centers powerfully influencing brainstem nuclei involved with descending pathways. Descending pathways can be changed by person’s level of vigilance, attention, and stress.

Question 10

What is the link between MSK pain and central sensitization?

Answer 10

Chronic pain evolves from MSK pain. For example massive peripheral input from whiplash which causes a change in the sensitivity of CNS. Thereafter, any additional trauma can cause bottom-up input on CNS and feed into central sensitization.

Question 11

A patient with ‘unexplained’ chronic MSK pain who is misinformed about pain demonstrate which tendencies?

Answer 11

more catastrophic thoughts and less adaptive coping strategies, and low treatment adherence.

Question 12

In a 2010 RCT by Ryan et al, was pain education (for chronic LBP patients) alone more beneficial than pain education and group exercise?

Answer 12

Yes education alone was more beneficial, in the short term, for pain relief and improving pain self-efficacy.

Question 13

What can we conclude from studies about pain education and motor performance (Ryan 2010 & Moseley ‘02,’04)?

Answer 13

Motor performance may be directly influenced by changes in pain perception.

Question 14

In studies examining pts with fibromyalgia or chronic fatigue syndrome, was providing the booklets about pain physiology effective?

Answer 14

No, but when the booklets were provided along with individually tailored face to face education sessions, they improved.

Question 15

What are some maladaptive pain cognitions, which can be used to identify a patient with central sensitization?

Answer 15

ruminating about pain and hypervigilance to somatic signs.

Question 16

What tools can be used to identify maladaptive pain cognitions?

Answer 16

‘Pain Catastrophizing Scale’, the ‘Pain Vigilance and Awareness Questionnaire’, and the brief ‘Illness Perception Questionnaire.’

Question 17

What is the key concept that chronic pain patients should be convinced of?

Answer 17

hypersensitivity of the CNS rather than local tissue damage is the cause of their presenting symptoms.

Question 18

what is the typical progression of a pain education session?

Answer 18

info about local nociception mechanisms presented first, then contrasted with central sensitization mechanisms. Patient encouraged to ask questions and info from pt is used to individualize the information.

Question 19

What are common cognitive impairments of patients with chronic pain, and what are the implications?

Answer 19

concentration difficulties, impairments in short-term memory, which implies they can forget verbal information. Therefore homework should include a book with info and pictures the same as from the face-to-face session.

Question 20

What can be used to assess the patient’s understanding of pain?

Answer 20

the ‘Neurophysiology of Pain Test’. Hand out to pt after first session and tell them to fill it out one day prior to their next session.

Question 21

What are some general recommendation for the 2nd session?

Answer 21

Answer questions from Pain Test they got wrong and explain. Identify behaviors they can modify. Like: stop ruminating about aetiology and nature of their pain, reduce stress, increase physical activity levels, decrease hypervigilance, relaxation etc.

Question 22

What can the ‘Pain Reaction Record’ (Sullivan 2003) be used for?

Answer 22

To help transition the pt from knowledge of pain, to adaptive behaviors. It is in easily applicable measure facilitating a cognitive approach to pain coping.

Question 23

What is one method to help ensure long term pain belief changes are happening during later treatment sessions?

Answer 23

Ask the patient to explain the rational behind a particular treatment. If they can’t explain, then reeducate, and continually look for maladaptive behaviors.

Question 24

If chronic pain patients experience side effects and symptom fluctuations, what should the PT do?

Answer 24

Explain these symptoms as part of the central sensitization model and shift the pt’s attention away from the somatic signs and towards adaptive coping strategies and reassurance.

Question 25

What is one patient perception that should be an outcome goal to constantly assess during therapy?

Answer 25

The patient’s confidence in the treatment.