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MSK 2 > Pain Science > Flashcards

Pain Science Flashcards

1
Q

what are the 2 criteria for a definition of pain

A
  1. pain can’t be replaced with the word fear and it still make sense (fear and pain are different things)
  2. definition needs to make sense for this patient
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2
Q

free nerve endings vs receptors in what they transmit

A

free nerve endings = send messages

receptors = send specific messages

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3
Q

what are primary afferents

A

first neurons to carry info toward the brain

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4
Q

what afferent fibers can have a specific receptor on the end

A

A-alpha
A-beta
A-delta
C

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5
Q

what is the speed of A-alpha afferent fibers and what is their function

A

highly myelinated
fastest fiber

proprioceptive functions from ms spindles and GTO
- ex: help you coordinate to stay upright

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6
Q

what is the speed of A-beta afferent fibers and what is their function

A

next fastest (after A-alpha)

decipher safe vs dangerous mechanical and thermal stim

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7
Q

what is the speed of A-delta afferent fibers and what is their function

A

slowest of myelinated primary afferents

detect hair follicle deflection
dangerous mechanical events

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8
Q

which of the primary afferent fibers are myelinated

A

A fibers

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9
Q

what is the speed of C afferent fibers and what is their function

A

unmyelinated, slow

detect safe vs dangerous mechanical, thermal, and chemical stim

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10
Q

what are free nerve endings

A

neuron doesn’t innervate specialized receptors

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11
Q

what is the optimal stimulus for free nerve endings

A

high intensity mechanical stim
- some may respond to temp

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12
Q

what is the advantage to the biology of free nerve endings

A

neuron itself is capable of generating action potentials rather than relying on a receptor at its terminal, such that the stim detection zone extends prox

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13
Q

what is a disadvantage to the biology of free nerve endings

A

can’t provide clear info ab the location of the stim
- pt will describe as general pain

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14
Q

what are the most prevalent and studied nociceptors

A

A-delta
C fibers

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15
Q

what stimuli do nociceptors respond to

A

stimuli that would damage tissue or would damage tissue if prolonged

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16
Q

what is the relationship to nociceptor activation and pain response

A

when nociceptors are activated doesn’t mach when a stimulus triggers pain

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17
Q

what is the relationship b/w nociceptor firing rate and tissue damage

A

nociceptor firing rate doesn’t match pain response

amt of damage to tissue doesn’t determine the firing rate of nociceptors

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18
Q

what is the relationship of quantity of nociceptors activated and pain response

A

number of nociceptors activated doesn’t match pain response

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19
Q

how does the duration of nociception firing relate to that of pain duration

A

the time course of pain doesn’t match the time course of nociceptor firing

ex: nociception happened and then dec w stim remaining constant –> pain cont to inc

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20
Q

what is the relationship between injury, nociception, and pain

A

the entire system is about protection and NOT about conveying an accurate indication of the state of tissues

21
Q

where do primary nociceptive neurons terminate

A

dorsal horn of gray matter on spinal nociceptor

22
Q

what is the pathway from the termination of primary nociceptive neurons on the dorsal horn of a spinal nociceptor

A

travels via periaquaductal gray and thalamus to brain
- brain assesses level of danger and need for action and will send either descending inhibitory or facilitatory to the spinal cord

23
Q

when does the brain send the signal to create the output of pain

A

determined there is sufficient evidence of threat and potential tissue damage

context supports need for protection

24
Q

what is the periaquaductal gray (PAG)

A

located base of brain

sum of all inputs from all sensory receptors throughout body

25
Q

according to functional knowledge, when do we experience pain

A

DIMS > SIMS

DIMS = dangers in me
SIMS = safety in me

26
Q

is pain a linear or emergent system

A

emergent

27
Q

what does it mean that pain is an emergent system

A

pain arises spontaneously from many interacting micro parts

28
Q

what do we have to provide if the patient has missing pieces of info

A

provide education to fill in the gaps
knowledge enrichment

29
Q

what does it mean that a patient has a single grain misconception

A

learner’s pain knowledge held in grains that are not deeply anchored, or elaborated into a more mature concept

“its just old age”
“metal in my back can get hot and burn me”

30
Q

what does it mean for a pt to have a sandcastle misconception

A

many concept neurotags are collaborating together

often multiple underlying misconceptions that are summarized in a single statement

“I am broken”
“I identify as busted lol”

31
Q

what does it mean for a pt to have a sandstone misconception

A

learner’s misconceived knowledge is so coherent that its extremely difficult to change
- more deeply psych rooted beliefs

“its a massive disc herniation - four specialists have told me and I can see it on the MRI. you can’t fix that”

32
Q

what is the goal when you are explaining pain to a patient

A

to create internal conflict for deep conceptual change

want them to see that it is their brain telling them they are in pain, not their elbow or knee

33
Q

what is pain neuroscience education (PNE)

A

use of biopsychosocial model of pain to educate pt ab neurophys of pain thru relatable stories and metaphors

34
Q

what should be your approach to pain (aka what are the pillars)

A

PNE +
goal setting, pacing, graded exposure
aerobic exercise
sleep hygiene

35
Q

in pts who have given up on controlling their pain

A

goal setting through pacing and graded exposure
- break down their goal so it is achievable

36
Q

what is the recommendation for aerobic exercise in pain

A

> 50% VO2max for >10min to elicit exercise induced hyperalgesia
-> endogenous opioids and neurochemical signaling

37
Q

what is graded motor imagery

A

top-down method utilizing principles of neuroplasticity to facilitate improvement in central processing and organization of the sensorimotor cortex

38
Q

who is graded motor imagery typically reserved for

A

people w highly sensitized systems

ex: CRPS, phantom limb, SCI, significant pain problem

39
Q

what are components of graded motor imagery

A

laterality training
implicit/explicit motor imagery
- visualization
- guided mvmt
- localization training
- mirror therapy

40
Q

are manual exercises top down or bottom up exercises

A

bottom up

41
Q

what is the first step in a graded motor imagery program

A

laterality training

42
Q

what is laterality training targetting

A

pts exhibiting central sensitization may have difficult time discerning L from R d/t central changes and rewiring

43
Q

how does visualization as a component of implicit motor imagery work

A

implicit imagery starts away from sensory area and move towards it - consider homunculus organization

guide Qs about what a particular mvmt should feel like or if an object was touching the area

neuron firing pre-empts mvmt

44
Q

why does visualization work

A

same neurons fire which create pain if they watch a mvmt that is painful for them as if they did it themselves

45
Q

once implicit motor imagery is mastered, what is the next step

A

explicit motor imagery

46
Q

what is explicit motor imagery

A

pt is guided through physical mvmt
- maybe initiate on uninvolved extremity and work back thru implicit mvmt questions as to what it feels like

47
Q

how can point localization training be utilized

A

to bring awareness to a particular area of the body and to remap the brain’s awareness of the area

48
Q

what can 2 point discrimination tell you

A

help you determine if there is central sensitization

if in more pain, less ability to discern

MSK 2 (20 decks)

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