Pain Science Education Flashcards
are pain and injury synonymous?
no
t/f: following RCT surgery majority had gained ROM, strength and fxn and yet their MRIs still showed abnormal findings and some still showed a tear
true
in asymptomatic elite tennis players, 33% had what findings on their scans?
spondylolithesis or fx
many hip MRIs in asymptomatic healthy ppl show what?
abnormalities and labral tears
a majority of ppl undergoing cervical spine MRIs have what finding, with no symptoms?
“bulging” disc
what does the biopsychosocial model cover?
biology, psychology, and social aspects of pain
t/f: we still prefer to use the biomedical model over the biopsychosocial model in healthcare
false, we are moving away from using the biomedical model
what is the definition of health according to the biomedical model?
freedom from disease, pain, or defect (focuses on the physical processes)
what are the 3 pain mechanisms?
nociceptive
peripheral neurogenic
central sensitization
what pain mechanism is proportionate pain?
nociceptive pain
what pain mechanism is pain in the dermatomal/cutaneous distribution?
peripheral neurogenic
what pain mechanism is disproportionate pain?
central sensitization
various types of input are sent to the SC and brain to be processed including what info?
tissues
environment
peripheral neurogenic info
what is the tissue input mechanism?
stimuli that activates nociception
what are the types of tissue input mechanisms?
temp
mechanical
tissue inflammation
neurogenic inflammation
immune activating
what type of tissue input mechanism activates myelinated A-delta and C fibers like in sprain, fx, or surgery?
mechanical
what type of tissue input mechanism is activated by extremes of cold and heat like frostbite and burns?
temp
what type of tissue input mechanism is activated by the release of chemicals to injured tissue of cell membranes or immune cells that release macrophages or histamine through mast cells?
tissue inflammation
what type of tissue input mechanism is activated by axons firing bi-directionally?
neurogenic inflammation
t/f: axons get stimulated and send info to the CNS and brain, but axons also fire backward towards the peripheral tissue and terminal ending (retrograde depolarization)
true
what is retrograde depolarization?
when the axons fire backward towards the peripheral tissue and terminal ending
what type of tissue input mechanism helps with impeding threats through through release of cytokines and macrophages when activated?
immune-activating
what is a positive environmental factor that is protective of developing chronic pain later in life?
playing contact sports early in life
what kind of injuries have a higher chance of developing persistent pain?
injuries in high stress situations like car accidents or having a stressful job
what is a strong predictor of if chronic pain and disability rates are high?
if unemployment rates are high
what cultures are less likely to complain about pain?
cultures that are stoic and communicate less expressively
what mechanisms are involved in peripheral neurogenic input?
ion channel expression
double crush/axoplasmic flow
blood supply to the NS
what is double crush/axoplasmic flow?
when there is compression at one site, it can lead to an axon being compromised at another (ie CTS, cervical radiculopathy)
t/f: aerobic exercise desensitizes the NS
true
CNS and brain processing info are sent by what systems?
input systems
what is involved in the processing mechanism?
processing of sensory, cognitive, and emotional input
what is the output mechanism?
the biological response to the system input and conclusion drawn from the processing
t/f: output mechanism is strongly driven by survival instinct
true, think about the bus example
what is nociceptive pain?
pain produced by normal processing of stimuli that damage tissues, such as pain that occurs in response to surgery or trauma
nociception is a 4 step process, what are those 4 steps?
transduction
transmission
perception
modulation/inhibition
what is transduction in the 4 step process of nociception?
the process that brings in response to tissue damage as a result of noxious/painful stim
what is transmission in the 4 step process of nociception?
the AP from damaged tissues is sent to the SC then to higher centers in the brain
what is perception in the 4 step process of nociception?
awareness of the pain (also heavily impacted by survival instincts)
what is modulation/inhibition in the 4 step process of nociception?
when substances released from neurons descending from the brain inhibit transmission of painful impulses
what type of pain is characterized by proportionate pain, associated aggravating/alleviating factors, intermittent sharp/dull ache/throb at rest, and no night pain/dysesthesia/burning/shooting/electric feeling?
nociceptive pain
what type of pain is characterized by pain in dermatomal/cutaneous distribution, positive neurodynamic and palpation, and hx of nerve pathology or compromise?
peripheral neurogenic pain
what types of pain is characterized by disproportionate pain, disproportionate aggravating and easing factors, diffuse palpation tenderness, and psychosocial factors
central pain
when would we use PNE for nociceptive pain?
when there is fear-avoidance, pain catastrophizing, or they ask specific questions about it
how can we help peripheral neurogenic pain?
create space, get it moving, get blood flow to it, and use PNE
what is involved in PNE+ for central pain?
cognitive therapies
movement ed
sleep ed
creating goals
what countries have the highest percentages of their populations suffering from body pain regularly?
AU, US, Canada, Mexico, Romania
what countries have the lowest percentages of their populations suffering from body pain regularly?
China, Nigeria, Singapore, Malaysia, Japan, and Kenya
t/f: African Americans and Caucasians are more likely to define pain as negative
true
t/f: Asian and Hispanics are more likely to define their pain as a positive experience
true
what is the most common sx of pain in children/adolescents?
headaches
t/f: prevalence rates of pain in children and adolescents is generally higher in girls and increased with age for most types of pain
true
the WHO guidelines for the management of chronic pain in children says that pain occurs in what proportion of children?
1/4 to 1/3 of children
the WHO guidelines for the management of chronic pain in children says that debilitating pain occurs in what proportion of children?
1 in 20 children
what ethnicity experiences the most chronic pain and high impact pain?
Alaskan Native
there are higher levels of chronic pain in what areas?
nonmetropolitan areas
there are lower levels of chronic pain in what areas?
metropolitan areas
what is the definition of regularly experienced chronic pain?
having pain most days or every day during the past 3 months
regularly experienced chronic pain is highest in what age, sex, and ethnicity?
those over 65
females
non-Hispanics
t/f: less education has been associated with more pain reported
true
what is pain science education?
education provided on neurobiology and neurophysiology of pain, and pain processing by the NS
t/f: studies show that PNE could reduce pain catastrophizing, disability, pain, and improve physical movt for MSK pain
true
pain is a normal human experience and essential to survival, but when does it become an issue?
when you are living with pain and culminates in the sufferer seeking help
what is congenital insensitivity?
when you don’t feel pain
can be life threatening bc we need pain to some extent to survive (ppl typically don’t live past 20s)
t/f: pathoanatomical, biomechanical, and anatomical models of education to explain pain have been shown to be effective for people with chronic pain
false, it not be shown to be effective and can actually make pain worse
t/f: when talking with pts, we should interview to dive into deeper questions about the pt’s pain
true
what should we establish with chronic pain pts during the IE?
their goals and an understanding of their pain
it is critical to gain _____________ for PNE
a pt’s trust
what questions would be good to ask a chronic pain pt during the IE?
what do you think is going on?
why do you think you hurt?
what do you think should be done?
where do you see yourself in 5 yrs?
what kind of approach should we use at the IE for a chronic pain pt?
a pt-centered approach
t/f: during a physical exam for a chronic pain pt, we should focus on smaller, precise movts
false, we should stay big and global
instead of assessing small movts in chronic pain pts, what movts should we assess?
larger fxnal movts
what tests and measures should we utilize in the physical exam of a chronic pain pt?
gross ROM
comprehensive neuro screen
appropriate special tests
neurodynamic tests
what words should we avoid when explaining your physical exam findings to a chronic pain pt?
fear-inducing words
what are the benefits of resistance training in chronic pain populations?
changes in cellular makeup by bringing in satellite cells to repair and grow exercised tissue
adaptation of muscles to the overload stress occurs immediately after exercise
remodeling of skeletal tissues
what is an important thing to explain to chronic pain pts about adaptation of muscles in response to resistance training?
that it can take weeks to months for the results to manifest physically, even though there are cellular changes that happen immediately
t/f: skeletal tissues are not very adaptable
false, they are very adaptable
what has to occur before neuroscience re-education?
de-education
what is involved in neuroscience education?
avoiding fear inducing words
educating staff on PNE language
remove provocative images in the working environment
use model and educational books/charts
utilize normative data for medical tests and imaging to help pts understand them
provide facts of epidemiology of extra sensitive systems and provide examples/reasons for having an extra sensitive system
use metaphors, pics, and examples
utilize “why do you hurt?” flashcards
what is the pain disability index (PDI)?
scale to measure the degree in which a person’s life is impaired by chronic pain using 7 categories
what are the 7 categories included in the PDI?
fam/home responsibilities
recreation
occupation
social activity
sexual behavior
life supporting activities
self care
what is the pain neurophysiology questionnaire (NPQ) and revised pain neurophysiology questionnaire (rNPQ)?
19/12 questions used to measure knowledge of pain
when may we use the NPQ or rNPQ?
pre and post education
as dialog for PNE
what are the pain self-management strategies?
ergonomics
pacing
liquid intake
meds
exercise
tension
sleep
shift focus (dual tasking)
thinking constructively
socialize
improving mood
what is an important way for chronic pts to utilize shift focus (dual tasking)?
to talk with a friend while walking
to listen to something while exercising
to generally think of something else during painful activity
t/f: exercise prescriptions for chronic pain pts should be pt-centered
true
what do we have to do to make exercise pt-centered?
have a convo with the pt about their goals
what are factors that affect exercise prescriptions?
age, comorbidities, PLOF, cultural background, current LOF, vulnerable populations
what positions might we consider when coming up with an exercise plan for chronic pain?
supine, sitting, standing, prone, SL, 1/2 kneeling, semi-lunge
t/f: with exercise for chronic pain, we should alternate ms groups to allow rest
true
should we use intermittent walking in our exercise plan for chronic pain?
yes!
what can we use for aerobic activity?
UBE
nu-step
bike
t/f: especially with sedentary individuals, we should think simple when starting an exercise program
true
what is involved in pacing during an exercise program for chronic pain?
ID the action, determine the timing, balance, learning, and self-management
what is pacing?
active self-management strategy whereby individuals learn to balance time spent on an activity and rest for the purpose of achieving increased fxn and participation in meaningful activities
what is the boom-bust cycle?
when chronic pain pts feel pretty good, then overdo it, and feel bad all over again
what is the dilemma in chronic pain?
the more they do, the more likely they are to experience pain, which leads to fear avoidance to movt and increased stiffness/pain
t/f: pacing=finding the middle ground
true
how many times a day should a chronic pain pt do their exercises on a good day? on a bad day?
3x/day on a good day or a bad day 3-5 consecutive days
t/f: pts should perform the same amount of time on exercise on both good and bad days
true
what should we tell our pts about taking breaks?
that it doesn’t make them weak, but it helps them be wise and increase stamina to enable increased participation and reduce/assist with pain
what are the possible benefits of humor for chronic pain pts?
can increase endorphin release from the brain
can increase then decrease your HR (resulting in relaxation)
stimulates circulation and ms relaxation
what level may we start a walking program with?
just 90 sec everyday adding 5 sec
t/f: studies showed a shift in physical activity level following a walking program (increased daily steps, improved fxnal disability/pain)
true
what is the 3 stage progression of graded motor imagery?
left/right discrimination
explicit motor imagery
mirror therapy
what is left/right discrimination?
IDing images as left vs right of the painful body parts to begin recognizing that part of their body again without provoking pain
what is a good starting point for treating CRPS?
left/right discrimination
what is explicit motor imagery?
thinking about the movt before actually doing it
what is mirror therapy?
using a mirror to create a reflection of the uninvolved body part to let the brain think you’re moving the involved body part
what things can we implement to increase pt compliance?
have them journal
give them an activity log
fitness apps
medbridge for their HEP
who is involved in interdisciplinary care for chronic pain?
physician/PA/CRNP
nurse
psychologist
nutritionist
PT
what are the power 9 blue zone characteristics?
move naturally
purpose
downshift
80% rule
plant based
wine at 5
right tribe
loved ones first
belonging
in a study of centenarians, what were some common characteristics?
feeling of belonging
incorporating natural movt into their lives
have a purpose
finding something each day to destress
not relying on too much tech
having a group of ppl who have similar values and look out for each other
