Pain Science Test 1 Flashcards
T or F
The brain decides when you will be experiencing pain
True
T or F
Special nerves in your spinal cord convey “danger” messages to your brain
True
Pain mechanism
Input :Tissues
Mechanical
Thermal
Chemical
Pain Sensitization
Increased responsiveness of nociceptive neurons to their normal input,
And/or
Recruitment of a response to normally sub-threshold inputs
T or F
Pain only occurs when you are injured
False
Processing via body-self neuromatrix
Sensory
Cognitive
Affective
Persistent firing of ___ will kill ___ with ___.
This is essence of ___.
C-fibers Over time will kill interneurons (gate keepers)
High levels of amino acids kill the interneuron
This is the essence of central sensitization
Flags…
Red: serious pathology
Orange: psychiatric (depression, personality disorders..)
Black: healthcare system (insurance limitations, legislation..)
Blue: work-related factors
Yellow: pain behavior, emotional responses, beliefs/appraisals/judgements
Decreased endogenous mechanisms
Consequence
Allodynia and Hyperalgesia
Increased sensitization/pain experience
STarT Back Scores
<4 low risk; suitable for primary care mgmt
> =4 medium risk; suitable for PT?
Psychosocial subscale score >=4
High risk; requires combo of physical and cognitive behavioral approaches
Intake scores predict 6 mo disability scores (but not pain or impairment)
T or F
Nerves adapt by making ion channels (sensors) stay open longer
True
Chronic pain % in US adults
3 months of some type of specific pain….
Widespread pain…
43% population (Specific body area)
11% chronic widespread pain
T or F
Chronic pain means an injury hasn’t healed properly
False
Inappropriate synapsing- other fibers
Consequence
Sympathetic, immune, motor contributions
Hyperalgesia
Increased pain from a stimulus that normally provokes pain
Other (non-pain) sensory afferents are ___ fibers
Fast fibers
Usually A-Beta
Cortisol -Tissues
Sore
Tired
Sensitive
Fatigued
Inappropriate synapsing - other levels
Consequence
Spreading pain
T or F
The brain can send messages down your spinal cord that can increase the danger messages going up the spinal cord
True
Pain mechanism
Outputs
Pain
Action programs
Stress regulation
Peripheral pain
Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields
T or F
When you are injured, special receptors convey the danger message to your spinal cord
True
Definition of pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Cortisol- immune
Cytokine signaling
Increased nerve sensitivity
Persistent inflammation
Brain plasticity
Cortisol - brain
Memory Sleep Concentration Blood pressure Reproduction
T or F
When you are injured, chemicals in your tissue can make nerves more sensitive
True
T or F
Pain occurs whenever you are injured
False
T or F
Nerves can adapt by increasing their resting level of excitement
True
T or F
When you are injured, the environment that you are in will not have an effect on the amount of pain that you experience
False
Inappropriate synapsing- other side
Consequence
Bilateral “mirror” pains
FABQ
Cutoff
Fear avoidance beliefs questionnaire
Screen for elevated fear-avoidance beliefs
Cutoff scores:
FABQ-PA >15
FABQ-W >29 (work related acute LBP)
FABQ-W >22 (general ortho pt/no compensation)
T or F
In chronic pain, chemicals associated with stress can directly activate danger messenger nerves
True
T or F
When part of your body is injured, special pain receptors convey the pain message to your brain
False
Unhealthy PNS
Retrograde firing of nerves…
Increased inflammation, swelling and immune response
PHQ-9 scores
0-4 no depression 5-9 mild depression 10-14 moderate depression 15-19 moderately severe depression 20-27 severe depression
Q10- any response besides “not difficult at all” is considered + for major depressive disorder and needs professional help
C-fibers pull back
A-fibers grown in
Consequence
Allodynia
T or F
The timing and intensity of pain matches the timing and number of signals in danger messages
False
Unregulation of 2nd-order neurons
Consequence
Increased firing towards brain
T or F
It is possible to have pain and not know about it
False
T or F
Worse injuries result in worse pain
False
CDC 2010- pain reported over 3 months
LBP 28%
Knee 19.5%
Neck 15%
Unhealthy PNS
Bombardment of C-fiber activity…
Into CNS dorsal horn resulting in permanent changes over time
T or F
Receptors on nerves work by opening ion channels (sensors) in the wall of the nerve
True
Depression screening:
Probability of severe depression decreases from __ to ___ with 1 negative response
And ___% of yes to both questions
20% to ~ 5%
50% chance if yes to both
CIPA: Congenital Insensitivity to Pain with Anhydrosis
Congenital disorder
Don’t feel pain
Frequent injuries/fractures
Most die by 3 y/o
Remaining don’t live to 25
FADQ
Fear of Daily Activities Questionnaire - identify fear of specific activities
10 movements/activities
Rate fear of each one on VAS
Average the first 10 items for FADQ score
Death of inhibitory neurons
Consequence
Decreased gating from the periphery
Weaknesses of Gate theory
- Ignores psychological/mood
- Over-simplified
- Premise: neural system is hardwired (research shows plasticity)
T or F
Second-order messenger nerves post-synaptic membrane potential (excitement) is dependent on descending modulation
True
T or F
Descending neurons are always inhibitory
False
Typical pain neural signature
- Premotor/Motor cortex
- Cingulate cortex
- Prefrontal cortex
- Amygdala
- Sensory cortex
- Hypothalamus/Thalamus
- Cerebellum
- Hippocampus
- Spinal cord
T or F
In chronic pain, chemicals associated with stress can directly activate danger messenger nerves
True
Multiple psychological factor screening
OMSQ
Orebro MSK screening questionnaire
12 items
Useful to identify work-injured patients at-risk of persistent MSK problems
PCS
Cut offs
Pain catastrophizing scale
11: 25th percentile
20: 50th percentile
31: 75th percentile
> 50th (20) suspicion of psychological influence
75th (31) consider (+) for psychological influence
T or F
The body tells the brain when it is in pain
False
T or F
Pain only occurs when you are injured or at risk of being injured
False
Allodynia
Pain due to a stimulus that does not normally provoke pain
Pain afferents are ___ fibers
Slow fibers
A-delta and C fibers
If patient is positive on the 2 question depression screen- consider..
Full questionnaire option PHQ-9
To assess diagnosis and severity of depression
(Q9 relates to suicide ideation)
Cut-off scores for OMPQ
<57 0 paid days off work
> 72 28 days or more off work
72 Poor recovery
72 NRS (severity of pain)
Score over 72, consider assessing specific factors
Central pain
Increased responsiveness of nociceptive neurons in the CNS to their normal or sub-threshold afferent input
TSK
Cut offs
Tampa Scale of Kinesiophobia
Assess pain-related fear and fear of re-injury (17 items)
11: 25th percentile
22: 50th percentile
33: 75th percentile
> 50th (22) suspicion of psychological influence
75th (33) consider (+) for psychosocial influence
T or F
In chronic pain, chemicals associated with stress can directly activate danger messenger nerves
True
T or F
Nerves can adapt by making more ion channels (sensors)
True
STarT Back
Subgroups for Targeted Treatment Back Screening Tool
Developed for back pain to assist GP referral to appropriate mgmt
Psychosocial subscore
___ miles of nerves.
Nerves need….
45 miles of nerves
Nerves need:
Space
Movement
Blood
Pain mechanisms
Input: Neuropathic
Ion channel expression
