Pain & homeostasis Flashcards
1
Q
what is an example of chronic central sensitization? what are the symptoms like?
A
- chronic whiplash patients
- usual upper body symptoms
2
Q
what can be injected into whiplash patients?
A
- saline injections
3
Q
where do you inject a whiplash patient?
A
- into infraspinatus and tibialis anterior
4
Q
did the control subjects and whiplash patients have similar sensitivity?
A
- similar widespread sensitivity from lumbar nerve root pain due to MRI - confirmed disc herniation of 6-24 months duration
5
Q
what is the strongest predictor of future lower back pain?
A
- previous experience of low back pain
6
Q
what is the strongest predictor of future NP?
A
- previous experience of NP
7
Q
what does more widespread pain lead to? (2)
A
- worse natural history and clinical outcomes
8
Q
what follows a low back pain episode even if symptoms are absent?
A
- paraspinal sensitivity follows a low back pain episode
9
Q
where do recurrences of low back pain usually occur?
A
- usually occur in the same location as previous episodes
10
Q
where does processing occur?
A
- facilitation and inhibition occurs at multiple sites
11
Q
what is the spinal cord involved in?
A
- sensory integration
12
Q
what is the brainstem known as?
A
- gain control centres
13
Q
what does the brain control? (2)
A
- perception
- response programs
14
Q
what is antinociception?
A
- dampens the incoming pain signals through local and distal inhibitory pathways
15
Q
what is pronociception?
A
- heightens body’s awareness to pain in an effort to reduce further potential tissue damage
16
Q
what antinociceptive processes happen in the brain? (4)
A
- thalamic gate
- attention control
- deconditioning
- relearning
17
Q
what pronociceptive processes happen in the brain? (3)
A
- reorganisation
- conditioning
- catastrophizing
18
Q
what antinociceptive process happens in the brainstem?
A
- descending inhibition
19
Q
what pronociceptive process happens in the brainstem?
A
- descending facilitation
20
Q
what are the antinociceptive processes that occur in the spinal cord? (2)
A
- gate control
- long term depression
21
Q
what are the pronociceptive processes that occur in the spinal cord? (2)
A
- central sensitization
- long term potentiation
22
Q
what are the antinociceptive factors in nociceptors? (2)
A
- adaption
- fatigue
23
Q
what is the pronociceptive process that occurs in the nociceptors?
A
- peripheral sensitisation
24
Q
what increases the likelihood of co- occurrence?
A
- mirror image
25
what are the interference patterns found in co- occurrence of pain?
- facilitation and inhibition
26
what are the four components of homeostasis?
- variable quantity
- receptor
- control centre
- effector
27
what is an example of blood pressure homeostasis?
- blood pressure
- baroreceptors
- brain stem
- vessel diameter, HR, SV
28
what is the variable quantity of pain?
- threat
29
what is the receptor of pain?
- nociceptor
30
what are the control centres of pain?
- multiple CNS centres
31
what are the effectors of pain? (2)
- physiology
- behaviour
32
what is the mature organism model?
- looks at how the brain and nervous system receives input, processes and outputs pain signals and what affect this has on the body
33
what is pain perception equal to in the mature organism model?
- pain perception is equal to sensory dimension
34
what are the two factors that output alters in the mature organism model?
- altered behaviour
- altered physiology
35
what is the neuromatrix theory of pain?
- describes pain as a multidimensional experience generated by various influences
36
what structure does the neuromatrix model have?
- cyclical model
37
what are the three stages of the neuromatrix model?
1. input
2. process
3. output
38
how do outputs become inputs in the neuromatrix model?
- happens via a feedback loop
39
what does the central nervous system do with inputs?
- central nervous system integrates many inputs
40
what is the central nervous system always on lookout for? (3)
threats including:
- danger
- damage
- infection
41
what does the central nervous system continually do?
- continually samples, consciously and unconsciously
42
how is information on the environment retrieved in the neuromatrix model?
- external
via sensory organs
43
how is information on tissue retrieved in the neuromatrix model?
- internal
- via interoceptive and humoral pathways
44
where does the brain sample from?
- samples from itself
45
how are past experiences built in the neuromatrix model?
- from previous injuries and adverse childhood experiences
46
what are the three dimensions of the neuromatrix model?
- sensory
- affective
- cognitive
47
what did processing in more detail show?
- multiple brain areas are activated
48
what are neurotags?
- networks of brain cells distributed across multiple brain areas work in synergy to produce outputs
49
what is the homeostatic region of the brain?
- hypothalamus
50
what system is needed?
- smart multisensory threat detection alarm action system
51
what does an alarm system always need?
- needs outputs
52
is pain an output?
- yes, pain is a protective output
53
how is the central nervous system involved in outputs? what does this increase?
- CNS co-ordinates outputs
- increases chances of survival
54
what can outputs be based on?
- predictive models
55
what is the predictive process?
1. neuromatrix input
2. process
3. output model requires modification
56
are pain neurotags exclusive or sufficient for pain?
- pain neurotags are neither exclusive to nor sufficient for pain
57
what do output predictions provide?
- provide faster responses to aid survival
58
what are predictions later calibrated by?
- calibrated by sensory stimuli
- confirmed or negated
59
what does the cyclical prediction process involve?
- prediction (outputs)
- sensory input (initial trigger & later calibration)
60
what can happen to the brain predictions?
- they can be tricked
61
what are the two types of central nervous system outputs?
- physiological
- behavioural
62
what is the short term physiology of central nervous system outputs?
- normal and adaptive
63
what is the long term physiology of central nervous system outputs?
- abnormal and maladaptive physiology
64
do physiological outputs always include pain?
- no
- may or may not include perception of pain
65
what does pain demand in physiological outputs? what is the highest priority?
- pain demands attention
- cortical output of highest priority
66
what is reduced by physiological outputs? (2)
- cortical processing capacity
- decision making speed
67
what is increased by physiological outputs?
- cognitive error rate
68
what system is activated by physiological outputs?
- visuomotor systems
69
what axes and activity are altered due to physiological outputs?
- hypothalamus pituitary adrenal axes
- SNS activity
70
what activity is modified by physiological outputs?
- immune activity
71
what two systems are inhibited by physiological outputs?
- digestive system
- reproductive system
72
what are the 5 unpleasant innate protective mechanisms of physiological outputs?
- pain
- immune system
- anxiety
- fatigue
- low mood
73
what does physiological output of pain result in?
- chronic pain
74
what does physiological output of immune system result in? (2)
- allergies
- autoimmunity
75
what does physiological output of anxiety involve and result in?
- involves fear/ fright/ flight
- results in phobias
76
what does physiological output of fatigue involve and result in?
- involves rest and recuperation
- results in chronic fatigue
77
what does physiological output of fatigue involve and result in?
- involves rest and reflection
- can result in depression
78
what can happen to sensitivity due to physiological outputs?
- can increase or decrease
- can get stuck
79
what type of response is sensitization? what learning does it involve?
- learned response
- non associative learning
80
what are the two determinants of chronic central sensitization?
1. magnitude (load) of nociception
2. time (duration) of nociception
81
what interventions should be involved in sensitization? (2)
- learning
- training
82
what is habituation?
- diminishing of an innate response to a frequently repeated stimulus
83
how do you de-sensitize allergies?
- non associative learning following exposure to an allergen
- intervention involving learning/ training
- habituation following graded exposure to diluted allergen
- immunotherapy
84
how do you de-sensitize phobias?
- non associative learning following exposure to a trigger
- intervention involving learning/ training
- habituation following graded exposure to the trigger
85
how do you de-sensitize chronic pain?
- non associative learning following mechanical stimuli
- intervention involving training or learning
- habituation following mechanical stimuli
86
how do you de-sensitize chronic pain following traumatic injury?
- habituation via brain training e.g., graded motor imagery, left/ right discrimination, mirror therapy
87
what are the three short term behavioural outputs?
- communicative pain behaviours
- protective pain behaviours
- social response behaviours
88
what are the three types of communicative pain behaviours?
- visual distress
- verbal expression
- paraverbal pain expressions
89
what are some examples of visual distress communicative pain behaviours?
- grimacing
- wincing
- crying
90
what are some examples of verbal expressions communicative pain behaviours?
- pain words
- swearing
91
what are some examples of paraverbal pain expression communicative behaviour?
- screaming
- whimpering
- grunts
- sighs
- moans
92
what response does protective pain behaviour involve and why?
- flight or fight response
- ends painful experience
93
what does protective pain behaviours send? what is learned?
- sends clear warning to anybody nearby
- learned avoidance of pain repetition > decreased use of injured body point
94
what does social response behaviour involve?
- involves others providing support and care
95
what are long term maladaptive behavioural changes? what do they decrease?
- long term avoidance of movement
- fear of movement
- decrease chance of survival
96
what is the fear of movement called?
- kinesiophobia
97
what does the longer somebody with LBP is off work mean? what should they do instead?
- means the less likely they are to ever return to work
- LBP patients recover better staying at work even if they are still in pain
98
what is pain strongly related to? what is the shared variance?
- assumed to be strongly related to disability
- shared variance less than 10%
99
what two models can be used when disability = pain?
- ICF framework
- Biopsychosocial model
100
why was there an exponential rise in work incapacity over the last quarter of the 20th century?
- due to low back pain
- psychological and social factors were believed to be associayed with this
101
what consequence does back pain have for society?
- work incapacity has an economic burden
102
how do you deal with behavioural outputs?
- change thoughts and feelings via CBT approach
103
what should you target when dealing with behavioural outputs? (2)
- target cognitive - evaluation and motivational affective inputs
104
describe the CBT approach
- reduce threats
- reduce emotional components
- change context
- simple messages can be useful
105
what are the three factors that CBT involve?
- behaviour
- feelings
- thoughts
106
what other treatment can be used for behavioural aspects other than CBT?
- cognitive functional therapy
107
what three factors does cognitive functional therapy involve?
- making sense of pain
- lifestyle change
- exposure with control
