Pain Flashcards
Gate Control Theory
Pain is the product of imbalance of small and large fiber input
Combination of:
-central control system (ascending) +
-processing (descending) control of sensory input
Neuromatrix Thoery of Pain
-Brain and spinal cord producers of pain (not tissue damage)
-CNS parts work together to produce pain
Neuromatrix Theory inputs
Cognitive:
-tonic input from brain (ie. cultural learning, past experience)
-panic input from brain (ie. expectation, anxiety, depression)
Sensory:
-phasic cutaneous sensory input
-tonic somatic input (ie. trigger points,deformity)
-visceral input (visual/vestibular)
Motivational-Affective:
-hypothalamic pituitary adrenal system
-noradrenaline sympathetic system
-immune system
-cytokines
-opiates
Neuromatrix Theory Outputs
Pain Perception:
-cognitive
-sensory
-motivational
Action Programs:
-involuntary
-voluntary
-social communication
-coping strategies
Stress-Regulation Program:
-cortisol
-NE
-cytokines
-immune system
-endorphins
Neuromatrix View of Pain (equation)
Nociception + threat = pain
-sometimes threat alone can cause pain
-focus on reducing the threat
Fear Avoiding Model
Perception of threat effects pain perception leading to positive or negative affects (fear/avoidance)
Pain Catastrophizing
Explain pain experience in exaggeration
Increases pain thru altered attention, anticipation, and emotional response
Stress Response to Pain
Receive sensory stimuli
Amygdala processes stimuli and perceives as stressful (w/ hippocampus -memories)
Long Term Response:
-signal pituitary -> adrenocorticotrophic hormone -> stimulate adrenal cortex -> cortisol -> maintain blood sugar thru stress response
Short Term Response:
-signal adrenal medulla -> NE/E released
Chronic stress
Negative feedback loop:
-Cortisol inhibits hypothalamus and pituitary
-Eventually lowers cortisol level which inhibits ability to control inflammation (immunosuppression)
-reduced BDNF in brain (repair and make new neurons)
-decreased function/size of hippocampus (mood/memory)
Effects of Sleep on Pain
Impairments stronger predictor of pain than vice versa
Dysregulation of endogenous opioids
Restorative/reparative function decreases (BDNF)
Memory consolidation
Cortical Changes (Homunculus) in Response to Pain
Size changes: body part representation grows
Laterality Recognition: difficult differentiating R/L
Smudge: representation blurs b/w parts in cortex; hard to tell borders of pain/sensation
Nociceptive pain dominant (cause and presentation)
Causes:
-stimulation of peripheral nociceptive fibers
-chemical, mechanical, thermal noxious stimulus
Presentation:
-pain localized and proportionate to injury
-response to aggravating/alleviating predictable
-intermittent/sharp w/ movement/provocation
-constant/dull ache at rest
Peripheral Neuropathic Pain Dominant (cause and presentation)
Cause:
-altered structure and function of peripheral nerve
Presentation:
-referred in dermatomal or cutaneous distribution
-provocation w/ tests that load neural tissue
Nociplastic/Central Sensitization (cause and presentation)
Cause:
-amplification of neural signaling in CNS that elicits pain hypersensitivity
-inhibition of descending inhibitory pain pathways
-> skews inhibitory/excitatory inputs that contribute to intensity, change in pain threshold, and spreading/radiation
Presentation:
-disproportionate pain (allodynia, hyperalgesia)
-diffuse pain
Pain Assessment (Severity)
Pain in expected proportion and distribution
Pain Assessment (Irritability)
Expected provoking and alleviating factors
Pain Asessment (Nature)
Pain symptoms match the nature of the condition ?
Pain Assessment (Stage)
Pain match the stages of healing and stage of injury?
Pain Assessment (Stability)
Stagnant?
Good prognosis
Positive affect
High self efficacy
Bad Prognosis
Negative affect
Low self efficacy
Biopsychosocial Assessment
- Type - mechanistic categorization
- Somatic factors - general constitution, other conditions
- Cognitive factors - understanding; learning level
- Emotional factors - distress/anxiety/depression
- Behavioral factors - contribution
- Social factors - contribution (stress sources)
- Motivation - self efficacy, affect
Quantity and Quality Assessment
Quantity: (not best option)
-VAS
-NPRS
Quality: better option
-patient characteristics
-location
-frequency/duration
-time of day
-activity and rest response
Goals w/ pain experience and beliefs
Understand pt unique suffering/experience
Motivate pt in goal setting
Establish therapeutic alliance
