Pain and Oedema

Question 1

Explain the pain gate theory

Answer 1

The gate control theory of pain describes how non-painful sensations can override and reduce painful sensations. The brain generates pain sensations by processing incoming noxious information from a stimulus like tissue damage. If noxious info. is to reach the brain it must pass through a metaphorical ‘pain gate’, which is located in the lower levels of the CNS. The gate is formed by excitatory and inhibitory synapses. The gate is opened by noxious events in the peripheral and can be closed by activation of mechanoreceptors or thermoreceptors (massage and thermotherapy), which generates activity in large diameter ABeta afferents, which inhibit the transmission of noxious stimuli in the small diameter afferents. The closing of the gate decreases the noxious information received by the brain therefore decreasing the pain sensation.

Question 2

What influences the output of pain?

Answer 2

• Context and meaning
• Previous experience and learning
• Genetics
• Thoughts

Question 3

What are the steps/ factors of pain assessment?

Answer 3

1. Intensity (VAS/NPS/FPS/BPI)
2. Depth: deep or superficial
3. Behaviour - intermittent or continuous, over 24hrs, night pain, aggravating or easing factors
4. Description (shooting, prickling, stabbing, sharp, burning, itching, tingling, dull, sickening)
5. % relief with medication
6. When did the pain start?
7. How did the pain start?

Question 4

What factors are used to classify oedema?

Answer 4

1. Pathophysiological mechanism
2. Location (Generalised/Local)
3. Clinical finding (pitting/non-pitting)
4. Organ specific

Question 5

How does oedema occur?

Answer 5

1. Increased capillary hydrostatic pressure
2. Decreased capillary colloid/osmotic pressure
3. Increased interstitial oncotic pressure
4. Increase in capillary permeability
5. Inadequate lymph drainage
6. Water retention in tissue

Question 6

Names the types of oedema

Answer 6

peripheral, pedal, pulmonary, cerebral, angioedema, hereditary, papilledema, macular, dependent, scrotal, lipedema, idiopathic, pitting/non-pitting

Question 7

What are the causes of oedema?

Answer 7

Medication
Excessive salt intake
Menopause and pregnancy
Malnutrition
Burns/heat
Diseases
Diabetes
Allergies
Obstructive sleep apnea

Question 8

What methods/tests can be used to diagnose oedema?

Answer 8

Blood tests
Liver function tests
Heart function tests
Venous ultrasonography
Lymphoscintigraphy
Urine tests
Chest X-rays

Question 9

What are the key points of effective Circumferential joint measure?

Answer 9

-Use non-stretch tape measure
-Use the same tape each time
-Same individual measure
-Measure at the same time each day
-Measure using the same bony landmarks
-Measure using the same technique
_Measure using the same unit of measure