Pain Lab

Question 1

Define peripheral and central sensitization

Answer 1

Peripheral sensitization – protective, inflammatory
Central sensitization – altered processing
nervous system more reactive,hypersensitivity to variety of stimuli
pain produced without tissue damage

Question 2

What are the effects of chronic nociception?

Answer 2

↓muscle activity and ↑sympathetic nervous system activity

Question 3

What are some theories regarding treatment while chronic nociception is occurring?

Answer 3

Motor retraining during chronic nociception might be fruitless

In chronic low back pain, treat the nervous system, not train TA.

Question 4

Explain the concept of dysfunctional endogenous analgesia

Answer 4

Exercise increases pain tolerance during and immediately after exercise (endogenous analgesia) in healthy individuals and individuals with OA and RA but not in some chronic pain conditions such as fibromyalgia, chronic whiplash (hence dysfunctional)

Question 5

What are the general risk factors for chronic pain?

Answer 5

Any MSK condition
Psychosocial factors
Words used by providers

Question 6

What types of MSK conditionsn can lead to chronic pain?

Answer 6

ANY

common conditions, traumatic and non-traumatic, can lead to chronic pain: any musculoskeletal condition such as degenerative disc disease, ankle sprain, whiplash; rheumatological disorders such as fibromyalgia, rheumatoid arthritis; others

Question 7

What kinds of psychosocial factors can lead to chronic pain?

Answer 7

Emotional distress and depression that develops with worsening pain
Lack of belief in ability to cope/manage pain
Baseline depressive symptoms and pain permanence beliefs
Catastrophizing
Fear-avoidance

Question 8

What sorts of words used by providers can lead to chronic pain?

Answer 8

Many- one example is degenerative disc disease; consider using age-related changes or gray hairs of the spine;

Question 9

What is pain physiology education and what are its goals?

Answer 9

1. identify central sensitization
2. face-to-face session on pain physiology education; not spine model of bulging disc or degeneration
3. written information on pain physiology education
4. follow-up face-to-face
5. re-education as indicated for return to maladaptive beliefs

Goals: Decreases catastrophizing, alters pain perception, improves movement

Question 10

What treatments do Nijs et al recommend in “Manual therapy targeting local problems in patients with central sensitization”?

Answer 10

•Avoid triggering more pain; treat below pain threshold
o Myofascial treatment
o Motor control training (movement efficiency, stabilization, postural advice, movement advice, self-management strategies, application of protective and supportive devices)
•Address inappropriate beliefs
•Pain neurophysiology education
•Aerobic exercise below pain threshold and without post-exertional symptom increase

Question 11

What are the manual therapy guidelines recommended by Nijs et al in “Manual therapy targeting local problems in patients with central sensitization”?

Answer 11

• Educate patient to report adverse reactions during treatment
• Do not elicit identical nociceptive stimuli > once 3 sec
• Adopt techniques to reduced sensory threshold
• Do not increase nociceptive barrage
• Initiate soft-tissue mobilization with superficial stripping techniques then deeper x-fiber
• Careful with ischemic compression

Question 12

What treatment is recommended by Nijs et al for decreasing afferent nociceptive barrage of trigger points?

Answer 12

Soft tissue mobilization

Question 13

What treatment is recommended by Nijs et al for improving appropriate sensory feedback to prevent sensory-motor conflict?

Answer 13

Motor control training

Question 14

What treatment is recommended by Nijs et al for addressing joint hypermobility?

Answer 14

Motor control training + movement advice + self-management strategies

Question 15

What treatment is recommended by Nijs et al for improving inappropriate beliefs (e.g. catastrophizing)?

Answer 15

Pain neurophysiology education

Question 16

What treatment is recommended by Nijs et al for stress management/stress reduction?

Answer 16

Relaxation + stress self-management techniques + breathing exercises

Question 17

What treatment is recommended by Nijs et al for decreasing fear of movement?

Answer 17

Graded exposure in vivo or low to moderate intensity exercise below pain threshold

Question 18

What treatment is recommended by Nijs et al for improving exercise capacity?

Answer 18

Low to moderate intensity exercise below pain threshold

Question 19

What treatment is recommended by Nijs et al for improving effort tolerance?

Answer 19

Low to moderate intensity exercise below pain threshold

Question 20

What treatment is recommended by Nijs et al for improving symptoms and daily functioning?

Answer 20

Low to moderate intensity exercise below pain threshold

Question 21

What treatment is recommended by Nijs et al for improving muscular blood flow?

Answer 21

Low to moderate intensity exercise below pain threshold

Question 22

Compare the efficacy of graded exposure vs. graded exercise

Answer 22

Exposure thought to be more efficacious

Question 23

How can you help the pt “access the virtual body?” (Note: not much on this, so don’t have a good definition - just note a few of the strategies on the other side of the card and move on).

Answer 23

 Imagine movements.
 Alter gravitational forces.
 Add varying balance challenges.
 Vary visual inputs.
 Alter the environment.
 Do the movement in different emotional states.
 Add distractions.
 Plan functional activities that involve bending.
 Break down the movement.
 Motion is lotion.
 Perform movements with neighboring tissue in “friendly” state.
 Playing with your “glitches” or habit movements.