Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuro for PT > Pain Management > Flashcards

Pain Management Flashcards

Lecture from 2/12/19

1
Q

What are the types of pain?

A

Mechanical
Chemical
Thermal

Acute
Chronic
Combination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is mechanical pain?

A

high levels of pressure on nociceptors

direct stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If it’s mechanical pain how will patient present?

A

intermittent bc there are positions where the pain is better/aggravated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is chemical pain?

A

“Chemically Mediated Pain”

Injury/Tissue damage 
↓
Bradykinins, prostaglandins, Substance P Inflammatory response
↓
Activation of nociceptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is thermal pain?

A

Extreme temperatures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is acute pain?

A

Activation of nociceptors

  • External (burn, cut, etc)
  • Internal (ligament/muscle damage)

Cell Destruction

  • Histamine, bradykinin, K ions, Substance P (directly stimulate nociceptors
  • Prostaglandins (increase sensitivity)
  • Hyperesthesia & Hyperalgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is hyperesthesia?

A

increased sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is hyperalgesia

A

increased pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is chronic pain?

A

pain that extends beyond normal course

Nociceptive Chronic Pain–continued activation of nociceptors due to disease

Neuropathic chronic pain–abnormality of pain neurons

CNS changes

Psychosocial effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how long to be considered chronic pain?

A

more than 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What helps to manage pain?

A

gate control theory-modalities

descending pain modulation

chronic pain management

medical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the Gate Control Theory (what structures does it include)

A

Melzak & Wall 1965

Dorsal horn of spinal cord

Inhibitory neurons
- gatekeeper for transmission to brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does the gate control theory work?

A

Pain and Touch interact

Dorsal horn of the spinal cord

Sensory information helps inhibit pain transmission

Large A-beta fibers (mechanoreceptors)

  • stimulate afferent
  • stimulate inhibitory
  • inhibit secondary neuron in spinal cord
  • low threshold neurons

BASIS FOR PT INTERVENTIONS
*Simplified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

**Add picture of the gate control theory

A

**add pic of gate control theory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Gate control theory simplified?

A

mechanoreceptors inhibit the pain signal?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the descending pain modulation?

A

Top Down

  • Nociceptive reflexes enhanced after SC transection
  • 1960s stimulation of PAG(periaqueductal gray ) =analgesia
  • PAG and RVM (rostral ventromedial medulla) involved in nociceptive processing
  • Higher areas of brain linked to PAG and RVM
  • —Cingulofrontal regions, amygdala, hypothalamus
  • —emotions and cognition have a role in processing nociception

Endogenous Opioids

  • At SC–inhibits Substance P from peripheral noxious mechanical stimulation
  • from release of noradrenaline from PAG and thermal nociceptive stimuli from release of serotonin from PAG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

image of descending pain modulatory system

A

insert image here

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are NSAIDS

A

Nonselective inhibitors of the enzyme cyclooxygenase (COX)

Inhibits COX-1 and COX-2

COX catalyzes the formation of prostaglandins and thromboxane (increases platelet aggregation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is acetaminophen

A

Highly selective for COX2 in CNS

Not considered an NSAID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are opioids?

A

Inhibition of NT release from primary afferent terminals in the spinal cord

Activation of descending inhibitory controls in the midbrain

Variety of brain regions (PAG, select descending pathways and specific neurons within dorsal horn) are susceptible to analgesic effects of opioids

These act to reduce the NT released from 1st order neuron, reducing level of activity to higher centers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the effect of marijuana? (Cannabinoid-induced analgesia)

A

Exogenously administered cannabinoids suppress nociceptive neurons in the dorsal horn without altering the activity of non-nociceptive neurons

Endogenous cannabinoids decrease the release of neurotransmitters to modulate neuronal excitability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can modalities help with?

A

healing

improving other interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what types of modalities are there?

A

thermal

acoustic

electrical

other??!?? (chemical, laser, dry needling…?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the point of modalities?

A

physiology

  • biophysical properties
  • physiological effects on tisssues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are indications of modalities?

A

acuity/stage of injury; area, patient preference, PT goals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the primary terms of thermal energy?

A

Conduction

Convection

Evaporation

Conversion

Radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is conduction?

A

energy transfers (heat is removed, cold is not added)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is convection?

A

heat transfer through movement

usually air or water

29
Q

what is evaporation

A 
causes energy transfer
vapocoolant sprays (very superficial)
30
Q

what is conversion

A

ultrasound and diathermy

acoustic or electrical energy is converted to heat

31
Q

Examples of heat?

A

MHP, paraffin wax, electric heat pad, wearable heat applicatiors, short wave diathermy, fluidotherapy, exercise

32
Q

What is the physiology of heat?

A

Increases Temp

Increases NCV

Vasodilation

Increases blood flow

Increases cell metabolism

Increases tissue extensibility

Decreases stiffness

Analgesia

33
Q

how does vasodilation occur? in heat

A

occurs via axon reflex, local spinal cord reflex, and a relesase of chemical mediators

34
Q

what is an axon reflex? for heat

A

heat stimulates skin thermoreceptors

impulse travels down spinal cord but some immediately to skin blood vessels

release vasodilators

result is cutaneous vasodilation

35
Q

what is local spinal cord reflex for heat

A

similar to axon reflex but impulses travel to and from spinal cord

upon return stimulate vasodilation of skin blood vessels

36
Q

what could application of superficial heat cause?

A

Mild Inflammatory Response

release of chemical mediators
histamine
prostaglandins
bradykinin

Vasodilation

Increase in capillary membrane permeability

Vasodilation+capillary membrane permeability= edema formation

37
Q

increase in metabolic rate for heat

A

level of production of metabolites manufactured by cells is elevated

results in increased oxygen consumption and increased circulation

38
Q

Analgesia for heat

A

most frequent reason for use of heat

mechanism usually attributed to gate control

also related to anti-spasmodic effects.

39
Q

what is anti-spasmodic effects? for heat

A

muscle spindle is hypersensitive during muscle spasms

heat decreases gamma efferent nerve activity

  • makes muscle spindle less sensitive
  • ultimately results in relaxing of muscle
40
Q

how does heat affect blood flow in cutaneous vs deeper tissues?

A

intra-muscular and intra-articular circulation not greatly affected by reflex mechanisms

controlled metabolically via hypothalamus

therefore, superficial heat is not likely to increase blood flow in deep tissue

41
Q

what would increase blood flow in deeper tissues?

A

exercise! (ultrasound is also deeper than other modalities but exercise is better because you essentially have 3 minutes between US and utilizing the heat from the US)

42
Q

does the heat stay once it is moved?

A

no

43
Q

what is homeostatic cooling?

A

as an area increases in temperature vasodilation and increased blood flow work to cool the area

highly vascular areas are more difficult to heat (muscle vs tendon/ligament)

44
Q

what might heat treatment depend on?

A

acuity/stage of injury

area

medical history

patient preference

physical therapy goals

45
Q

What are some indications for heat?

A

Pain

Muscle Spasm

Subacute or chronic inflammation

decreased ROM

Joint contracture

Hematoma resolution?

46
Q

Precautions of heat?

A

scars (bc no sensation and it wont have blood flow so it can burn)

patients with decreased sensation

  • diabetic, or peripheral neuropathy
  • CVA/TIA
  • MS
47
Q

what are some contraindications for heat?

A

Pregnancy
-lumbar spine or abdomen

Active Infection

Known CA/malignancy

Lack of thermal sensitization

Vascular insufficiency or disease

Areas of recent or potential hemorrhage

Open wounds

Acute inflammation

48
Q

What are types of cryotherapy?

A

commercial ice packs

continuous cold compression units

ice massage

vapocoolant sprays

ice baths

whirlpool

contrast baths

49
Q

what does ice do?

A

decreases NCV

increases threshold for depolarization

decreases metabolism

decreases o2 demands of tissue

vasoconstriction

increased stiffness, decreased tissue extensibility

increased blood viscosity

decreased pain

decreased inflammatory cells

decreased swelling after acute injury

alters muscle force generation and proprioception/neuromuscular control

50
Q

how does vasoconstriction happen with ice?

A

blood flow in cutaneous tissues regulated by sympathetic nervous system

theromreceptors
↓
sympathetic nerves
↓
vasoconstriction
51
Q

vascular effects in deeper tissues?

A

Deeper tissue temperatures regulated by metabolic control, not sympathetic nerves
via hypothalamus

Cold Application will cause:
Vasoconstriction in periphery
↑ in metabolism & heat products at core
Therefore minimal vasoconstriction in deeper tissues

Sacrifice extremities to save the core

52
Q

can cold affect deeper tissues than heat?

A

it may be able to.

deep tissues take longer to cool, but also longer to re-warm

53
Q

what re the analgesic effects of ice therapy

A

Cryotherapy will ↓ sensation of pain
Perhaps best reason to use it !!!

Mechanisms
Nerve Conduction Velocity
Raises threshold of sensory receptors
Lowers overall speed of transmission
Probably main reason for ↓’s in pain w/cold

Gate theory
Bombardment of receptors with large amount of stimulus “closes” the gate

54
Q

anti spasmodic effects of cold?

A

Cold raises threshold of muscle spindle
Makes it less sensitive to stimulus

Cold decreases pain by lowering NCV

Both contribute to reduction in:
Pain → Spasm → Pain Cycle

55
Q

anti inflammatory effects of ice?

A

Rationale

1. ↓ in circulation
2. ↓ in pain
3. ↓ in metabolic rate
56
Q

metabolic rate effects of ice?

A

Cold thought to slow metabolic events associated with inflammation

Decrease in release and production of chemical mediators of inflammation

Hypoxic Cell Death Theory
Tissue injury → compromise in circulation & oxygen delivery
Uninjured cells become hypoxic and die
Further cell death causes more cellular debris
↑’s interstitial osmotic pressure → ↑’s edema

57
Q

what is hypoxic cell death theory?

A

Cold thought to ↓ hypoxic cell death

Slows cellular metabolism

↓’s oxygen demand

Less cells die from hypoxia

Finger amputation example\

You can cool it just don’t FREEZE
it

58
Q

indications for ice?

A

Acute trauma – pain, edema, muscle guarding, limit secondary hypoxic injury
Pain
Muscle Spasm
Spasticity

59
Q

concerns w application of ice?

A 
Patient reaction to cold 
Uncomfortable Cold
Stinging
Burning (aching, warming)
Numbness
Studies: Knowledge of these made pts less anxious treatment
60
Q

precautions for ice?

A

Decreased sensation
HTN (cold can increase BP transiently)
Open wound
Superficial peripheral nerves (medial epicondyle of elbow, fibular head) due to possible injury (1-2 hours of cold)

61
Q

contraindications for ice?

A

Cold Hypersensitivities
Raynaud’s
Cold urticaria
Cryoglobulinemia

Neuropathy/nerve regeneration

Superficial peripheral nerve

Compromised circulation
Issues with re-heating or re-cooling
PVD

Anesthetized area

Wounds/Infection
Decreased metabolic activity

62
Q

what is raynauds phenomenon?

A

Vasospasm (extreme vasoconstriction) in extremities

Results in ischemic pain
Signs → pain, bluish coloring of skin

Common in individuals w/ rheumatic diseases (lupus, scleroderma)

63
Q

what is cold uticaria

A

Allergy to cold
Similar to anaphylactic rxn
Signs → hives, itching, eventual respiratory distress

64
Q

what are other less common ice hypersensitivities?

A

Cryoglobulinemia, hemoglobinuria

Abnormal proteins in blood that become gel like in cold

65
Q

what should you document with modalities?

A 
Type of modality
Area
Time
Goals
Effects 
- Subjective 
- Objective
66
Q

heat vs cold? what should you think about?

A

Stage of Injury

Signs of inflammation, not just time period

Body part / Tissue depth

Duration of physiological effects

Precautions/contraindications

What pt will/can do at home

What are you trying to accomplish?

Pt preference

67
Q

what is central sensitization?

A

Changes in the CNS with chronic pain

  • Dorsal horn of thespinal cord and in the brain
  • Cellular level, such as at receptor sites

Allodyniaandhyperalgesia

Predisposing factors

  • Anxiety
  • Trauma
  • Depression

Clinically:
- Fear-avoidance (FABQ)

68
Q

what is therapeutic neuroscience education?

A

ISPI

Use of neuroscience education to empower patients

address physical impairments

address psychosocial concerns

69
Q

look @ the case study @ end of this ppt

A

look @ the case study @ end of this ppt

Neuro for PT (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions