Pain Flashcards
acute pain definition
pain that occurs as a direct result of tissue damage or potential damage
a symptom
chronic pain definition
pain that outlasts normal tissue healing time
pain definition
unpleasant sensory and emotional experience associate with actual or potential tissue damage
how do pain and nocioception compare
different phenomena
nociception is picked up by sensory neurons
pain is associated with a ____ state
stress
what chronic pain conditions are known to change what
neuroplastic changes in S1
chronic LBP
CRPS
Phantom Limb
cortical reorganization
grey/white matter changes in S1 due to pain
what does cortical reorganization lead to
changes in acuity and interpretation of all peripheral stimuli
what is the neuromatrix theory an evolution of? what does it state
gate control theory
networks of neurons in the brain create a neurosignature that projects to areas if the brain associated with pain, motor output and movement
what are the brain areas included in the neuromatrix theory
thalamus
cortex
limbic system
what is a neurosignature modulated by
sensory and cognitive outputs
- individualized responses to nociception
inputs in the neuromatrix theory
cognitive related
sensory signaling
emotion related areas
outputs in the neuromatrix theory
pain reception
action programs
stress regulation
nociceptive pain
pain that arises from actual/threatened damage to non-neural tissue
due to activation of nociceptors
characteristics of nociceptive pain
localized
increases with movement
proportional to trauma
initial inflammation with a gradual decrease
responsive to NSAIDs
what does nociceptive pain lack
night/sleep disturbances
abnormal sensations
constant pain
peripheral neuropathic pain def
arises as a direct result of a lesion or disease affecting the somatosensory system
characteristics of peripheral neuropathic pain
in a dermatomal or cutaneous distribution
history of nerve injury or compromise
pain with nerve testing
characteristics of nociplastic pain
hypersensitivity
disproportionate
non-mechanical
unpredictable
non-specific
possible nociplastic pain characteristics
> 3 months
regional pain
not nociceptive or neuropathic
clinical signs of hypersensitivity
probable nociplastic pain
hypersensitivity to almost every sort of stimuli
sleep disturbances
fatigue
cognitive problems
in a pain pie, what is the crust and what is the center
crust - context factors
filling - type of pain
depression will cause
pain to be heightened with a longer time to decrease the pain
reduce pain threshold due to constant inflammatory state
depression definition
mental health disorder characterized by persistent unhappy mood or loss of interest
fear avoidance beliefs
avoidance of activities in which pain has been experienced
what is fear avoidance often associated with
depression
pain catastrophizing
tendency to describe pain in a more exaggerated way
components of pain catastrophizing
magnification
rumination
helplessness
magnification vs rumination
magnification - experiencing pain at a larger scale
rumination - focus on pain
what is pain catastrophizing often associated with
lower systemic endorphin levels
what does pain catastrophizing predict
persistence
severity
disability
self efficacy
belief in one’s ability to succeed in specific situations
process expectations vs overall expectations
process - what patient expects to happen with therapist interaction
overall - how patient perceives their ability to get better
> self efficacy is associated with
greater systemic endorphin levels
screens for chronic pain
orebro msk pain questionnaire
STarT back
significant score on the orebro MSK questionnaire
> 50
- more likely to have chronic pain within a year
significant score on the STarT back
4 or more
what is the exam for Pain Catastropizing? what score is significant?
PCS
> 30
what is the exam for kinesiophobia? what score is significant?
TSK-11
11 to 44 with higher being more avoidant
what is the exam for fear avoidance? what score is significant?
FABQ
>34 for work
>15 for physical activity
how are nociceptive and neuropathic pain perceived on the SINSS model
normal
specific measurements for nociplastic pain
allodynia - vibration or brush
hyperalgesia - pain pressure threshold
neurodynamic testing
plan of care for a patient with symptoms of mental illness
referral and communication with health care providers
plan of care for a patient with signs of severe mental illness?
immediate referral and communication with health care providers
initiate emergency care response
nociceptive pain management
exercise
manual therapy
TENS
neuropathic pain management
exercise in order to promote global blood flow
nociplastic pain management
education
systemic exercise
manual therapy
TENS
what impacts outcomes significantly in MSK pain
non-specific treatment
- aka more general movement and systemic processes
placebo vs nocebo
p - positive response to an inactive treatment
n - negative response to an inactive treatment
what treatments have the most significant effect on MSK pain
nonspecific treatment
natural history
