Pain

Question 1

Pain definition

Answer 1

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”

Question 2

Pain

Answer 2

Pain is useful
Protective function
Keeps us away from danger
Allows us to heal
Leads to adaptation
Can be maladaptive

Question 3

Fear avoidance cycle-

Answer 3

Negative thoughts-
Pain catastrophising
Pain-related fear
Aoidance Hypervigilance
Disuse depression disability
Injury
Endless cycle

No fear
Confrontation
Recovery

Question 4

Does pain reflect the state of the tissues?

Answer 4

The longer pain persists the less predictable the relationship between pain and the state of tissues (Moseley 2007)

Question 5

Types of pain

Answer 5

nociceptive pain
Nociplastic pain
Neuropathic pain

Question 6

Nociceptive pain

Answer 6

“Pain that arises from actual or threatened damage to non-neural issue and is due to the activation of nociceptors” (IASP Terminology 2017)

Question 7

Nociplastic pain

Answer 7

“Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.” ( Kosek et al. 2016)

non specific lower back pain

Question 8

Neuropathic pain

Answer 8

“Pain caused by a lesion or disease of the somatosensory nervous system”

Question 9

Acute pain

Answer 9

Pain that is temporarily related to injury and that resolves during the appropriate healing period. It is usually short-lived.

Easily described- sharp, stinging, pulling
Specific location
Specific aggravating and easing factors

Question 10

Chronic pain

Answer 10

Chronic pain is any pain that lasts beyond the expected period of healing or exists for more than three months.

Difficult to describe
May move locations
Difficult to pin point things that make it better and worse

Question 11

Periphery-detectors -sensory

Answer 11

noxious stimuli- Events that damage or threaten to damage tissues and that activate specialised sensory nerve endings called nociceptors.

Thermal, mechanical and chemical

Mechanical - rotation/torque beyond joints normal ROM

Mechanical - blunt force, stretching, crushing and overus

Mechanical (distension, traction on the mesentery) and chemical (released from inflamed or ischemic organs, inhaled irritants).

Question 12

Nocicpetion
Pain Gate Theory -Decending Modulatory System (Brain stem)-The Brain- Neuromatrix theoryWhole system- Predictive processing

Question 13

Rostral ventromedial medulla (RVM) in the brainstem

Answer 13

Determines whether nociceptive information is prioritised in the dorsal horn of the spinal cord.

Descending modulatory system.
Antinociceptive (Good cop)
Norepinephrine, serotonin
Pronociceptive (Bad cop)

Rats with high amount of descending inhibition recoveredm those with a small amount of descending inhibition did not (Felice et al., 2011)

Question 14

What has been shown in neuroimaging studies with t he descending modulatory system (Tracey 2011)

Answer 14

That the descending modulatory system is influenced by regulating cognition and emotions.

High working memory load significant less activity at the spinal cord and signficiantly less pain (Sprenger et al., 2012)

Question 15

Pain control theory

Answer 15

Activation of nociceptors must reach a threshold to travel to the brain and be interpreted as pain. This threshold may be equated to the “pain control theory”

Question 16

Central sensitisation

Answer 16

Where nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways.’

Seen in the short-term with tissue damage (hyperalgesia) and in the long-term with chronic pain conditions (Woolf and Salter 2000).

Question 17

What information is added at the brain

Answer 17

Past experience (memory), personality, beliefs, attention, fear/worry, mood, thoughts

Question 18

Neuromatrix theory

Answer 18

Pain is a multi dimensional experience

Produced by a characteristic “neurosigniture” patterns of nerve impulses

Generated by a widely distributed neural network “neuromatrix” within the brain.

They can be triggered by sensory inputs but can be generated independently of them (Melzack 2005)

Question 19

Neurosignature

Question 20

Predictive processing bi-directional

Answer 20

Expectations and beliefs ‘priors’

Predictions compared against actual sensory input

Error or success –> learning

Predictions driven (top down)
Data driven (bottom up)

Question 21

Protectometer: SIMS and DIMS

Answer 21

SAFETY messages in me SIMs (DOWN- desensitise)

Supportive family and friends, useful knowledge, fitness and mobility, hope, positive attitude/expectation, positive past experience, resilience, acceptance, healthy and balanced diet, love and friendship.

DANGER message in me DIMs (UP- sensitise)

Low expectation, poor sleep, reducing movement and activity, negative attitude, worry, perceived injustice, bad past experiences, no hope, fear, low mood, lack of support, lack of knowledge or incorrect messages, loss of identify or role (job, family role), poor health of tissues, poor diet, loneliness and isolation

Question 22

Our role

Answer 22

We as a HCP can be part of a SIM or DIM

How pain relief is given (Amanzio et al. 2001)
The HCP and patient relationship (Kaptchuck et al. 2008)
Your own optimism or pessimism matters (Galer 1997)
Identify, acknowledge and embed in treatment, the affect of
Family dynamics- parental responses to pain and illness behaviour (Levy et al. 2000, 2001, 2002, 2004, 2006, 2010, 2013)
The environment and emotions
Memory, Beliefs, Expectation and Past Experience

Question 23

Pain gate theory

Answer 23

Suggests that the spinal cord contains a neurological ‘gate’ that either blocks pain signals or allows them to continue on to the brain

Takes place in the dorsal horns of spinal cord. Thesse are areas of grey matter. Both small and large nerve fibres carry information to two areas of dorsal horn. One part is transmission cells - carry information up to the brain.

Other is inhibitory interneurons that either halt or impede the transmission of sensory information.

Question 24

Descending modulatory system

Answer 24

In adults, pain perception is modulated by the descending pain modulatory system, allowing environmental, contextual, and cognitive factors to influence our pain experiences.