Pain

Question 1

What is nerve pain?

Answer 1

Sharp
Lancinating
Bright
Burning
Shooting
Pins and Needles
Often following pathway of nerve

Ie: nerve root impingement, traction injury, carpal tunnel, sciatica

Question 2

What is Bone Pain?

Answer 2

Acute
Sharp
Severe
Intolerable
Ie: Fracture

Other:
Deep
Boring
Very localized

Ie: bone bruise, metastatic bone cancer

Question 3

What is Joint Pain?

Answer 3

Acute:
Sharp
Localized

Ie: Grade 2 ACL tear/sprain, labral tear, meniscal tear

Subacute/Chronic:
Dull
Achy
Can be localized or not

Ie: Chronic Ligament tears

Question 4

What is Muscular Pain?

Answer 4

Dull
Achy
Cramping
Often not localized

Question 5

What is Vascular Pain?

Answer 5

Diffuse
Achy
Throbbing

Ie: coronary artery disease, vasculitis

Question 6

What is Visceral Pain?

Answer 6

Diffuse
Achy
Poorly localized

Ie: appendicitis, IBS, food allergies

Question 7

4 Types of Behaviour of Pain

Answer 7

1. Constant
2. Mechanical
3. Episodic
4. Irritability

Question 8

What’s Constant Pain?

Answer 8

Unrelenting pain, even at night

Pain may fluctuate in severity but is always present

Typically chemical in nature, inflammation activates local nociceptors

RED FLAG FOR TUMOURS, VISCERAL LESIONS, CHEMICAL IRRITATION

Question 9

What is Mechanical Pain?

Answer 9

Brought on by certain movements

Related to stress on a specific anatomical structure

MCL sprain, meniscal tear

Question 10

What is Episodic Pain?

Answer 10

Related to specific activities, postures

Tends to come and go

Increasing frequency as time progresses

Often related to an ongoing disease process

Ie: DDD, facet joint syndrome, IBS

Question 11

What is Irritability Pain?

Answer 11

Refers to the ease with which symptoms can be exacerbated

Indicator of stage of healing

Question 12

Peripheralization vs. Centralization

Answer 12

P: Vs. C:

Pain travels further from source. Pain travels closer to source
Pain decreases in intensity. Pain increases with intensity
Occasionally pain will disappear at the source of irritation

Question 13

When does Chronic Inflammation pain occur?

Answer 13

Typically presents as morning stiffness and pain with improves with activity

Question 14

When does Joint or Soft Tissue Inflammation pain occur?

Answer 14

Typically presents later in the day as the patient as placed more stress on the tissues

Question 15

When does Tumour pain occur?

Answer 15

Night pain, constant pain, often accompanied by fatigue and weight lose in later stages

Question 16

Acute Stage

Answer 16

Inflammatory Stage

4-10 days (1-4 days)

Goal: Restore tissue homeostasis

Process:
1. Clotting ~ increased local blood vessel permeability causes a leakage of plasma proteins and the formation of an extravascular clot

2. Chemical Mediators:
   Bradykinins - attracts neutrophils and macrophages
   Neutrophils - help clear bacterial and fungal pathogens
   Early inflammation stage
   Macrophages - same as neutrophils but also clear out dead cell
   Cells and debris, releases platelet growth factors
   To lay doesn’t foundation for the proliferation phase
   Later Inflammatory Stage

Question 17

Function of a clot?

Answer 17

1. To hold would edges together
2. To create a mechanical barrier to foreign material entering the wound
3. To help prevent spread of infection

Question 18

What other structures also release Platelet Derived Growth Factors (PDGF)?

Answer 18

Platelets

Smooth muscle cells

Endothelial Cells

Question 19

Signs of Inflammation

Answer 19

1. Heat/Redness
2. Pain
3. Swelling

Question 20

What is Inflammatory Exudate?

Answer 20

A fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation and is deposited in nearby tissues

Includes: Gamma Globulins
Leukocytes: Neutrophils, Macrophages, Lymphocytes,
Basophils

Question 21

Treatment goals for Acute Inflammatory Stage

Answer 21

1. Decrease Bleeding: RICE for first 24/48 hours, NSAIDS
2. Decrease pain: RICE first 24/48 hours
3. Help remove excess inflammatory exudate a: METH
4. Promote good scar tissue adhesion: gentle ROM within pain
   Tolerance, gently massage, pulsed ultrasound

Question 22

M.E.T.H meaning

Answer 22

Movement

Elevation

Traction

Heat

Question 23

Subacute Phase

Answer 23

Proliferation Phase

10 days - 7 weeks (4-6 days to 15 days)

Goal: Granulation and Scar Tissue Formation

Process:
1. Granulation tissue is new connective tissue with capillaries that form on the surfaces of a wound during the healing process.

2. As each new capillary loop brings nutrients and oxygen to cells, fibroblasts are able to build more matrix and allows more macrophages and cells to migrate. Fibroblasts develop into myofibroblasts (wound contraction)
3. Collagen Fibers (Formed by fibroblast) are formed and if left on their own form bundles that are not oriented in any particular direction. Coleen at this stage is weak and vulnerable to tearing

Question 24

What does Granulation Tissue consist of?

Answer 24

Macrophages

Fibroblasts

Endothelial Cells

Question 25

Treatment Goals for Subacute

Answer 25

1. Fiber Orientation ~Mechanical Forces: AROM to orientate fibres along lines of Stress. Gentle Massage ~ Ultrasound: Increase collagen production and tensile strength Of the scar 2. Protection: scar tissue is still quite vulnerable and needs to be Protected. Stress is kept to a minimum

Question 26

Chronic Stage

Answer 26

Remodelling/ Maturation Phase Greater then 7 weeks (15 days -months up to several years) Goal: Scar tissue remodelling Process: 1. Basically Granulation tissue is being replaced by large bundles Of collagen scar tissue 2. Maturation (remodelling): main focus is to realign the collagen which began in the proliferation stage. Cells that are no longer needed are removed by programmed cell death "apoptosis" * Remodelling can last many years*

Question 27

Treatment Goals for Chronic Stage

Answer 27

1. Optimum collagen Orientation: increasing vigorous and direction oriented exercise and deep transverse frictions if needed 2. Return to regular activity

Question 28

Nature of Pain Types

Answer 28

1. Nerve pain 2. Bone Pain 3. Joint Pain 4. Muscular Pain 5. Vascular Pain 6. Visceral Pain