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Pain Science > Pain Science Test 1 > Flashcards

Pain Science Test 1 Flashcards

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1
Q

T or F

The brain decides when you will be experiencing pain

A

True

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2
Q

T or F

Special nerves in your spinal cord convey “danger” messages to your brain

A

True

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3
Q

Pain mechanism

Input :Tissues

A

Mechanical
Thermal
Chemical

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4
Q

Pain Sensitization

A

Increased responsiveness of nociceptive neurons to their normal input,
And/or
Recruitment of a response to normally sub-threshold inputs

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5
Q

T or F

Pain only occurs when you are injured

A

False

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6
Q

Processing via body-self neuromatrix

A

Sensory
Cognitive
Affective

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7
Q

Persistent firing of ___ will kill ___ with ___.

This is essence of ___.

A

C-fibers Over time will kill interneurons (gate keepers)

High levels of amino acids kill the interneuron

This is the essence of central sensitization

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8
Q

Flags…

A

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

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9
Q

Decreased endogenous mechanisms

Consequence

A

Allodynia and Hyperalgesia

Increased sensitization/pain experience

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10
Q

STarT Back Scores

A

<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)

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11
Q

T or F

Nerves adapt by making ion channels (sensors) stay open longer

A

True

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12
Q

Chronic pain % in US adults
3 months of some type of specific pain….
Widespread pain…

A

43% population (Specific body area)

11% chronic widespread pain

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13
Q

T or F

Chronic pain means an injury hasn’t healed properly

A

False

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14
Q

Inappropriate synapsing- other fibers

Consequence

A

Sympathetic, immune, motor contributions

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15
Q

Hyperalgesia

A

Increased pain from a stimulus that normally provokes pain

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16
Q

Other (non-pain) sensory afferents are ___ fibers

A

Fast fibers

Usually A-Beta

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17
Q

Cortisol -Tissues

A

Sore
Tired
Sensitive
Fatigued

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18
Q

Inappropriate synapsing - other levels

Consequence

A

Spreading pain

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19
Q

T or F

The brain can send messages down your spinal cord that can increase the danger messages going up the spinal cord

A

True

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20
Q

Pain mechanism

Outputs

A

Pain
Action programs
Stress regulation

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21
Q

Peripheral pain

A

Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields

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22
Q

T or F

When you are injured, special receptors convey the danger message to your spinal cord

A

True

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23
Q

Definition of pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

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24
Q

Cortisol- immune

A

Cytokine signaling
Increased nerve sensitivity
Persistent inflammation
Brain plasticity

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25
Q

Cortisol - brain

A 
Memory 
Sleep 
Concentration 
Blood pressure 
Reproduction
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26
Q

T or F

When you are injured, chemicals in your tissue can make nerves more sensitive

A

True

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27
Q

T or F

Pain occurs whenever you are injured

A

False

28
Q

T or F

Nerves can adapt by increasing their resting level of excitement

A

True

29
Q

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

A

False

30
Q

Inappropriate synapsing- other side

Consequence

A

Bilateral “mirror” pains

31
Q

FABQ

Cutoff

A

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)

32
Q

T or F

In chronic pain, chemicals associated with stress can directly activate danger messenger nerves

A

True

33
Q

T or F

When part of your body is injured, special pain receptors convey the pain message to your brain

A

False

34
Q

Unhealthy PNS

Retrograde firing of nerves…

A

Increased inflammation, swelling and immune response

35
Q

PHQ-9 scores

A 
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

36
Q

C-fibers pull back
A-fibers grown in

Consequence

A

Allodynia

37
Q

T or F

The timing and intensity of pain matches the timing and number of signals in danger messages

A

False

38
Q

Unregulation of 2nd-order neurons

Consequence

A

Increased firing towards brain

39
Q

T or F

It is possible to have pain and not know about it

A

False

40
Q

T or F

Worse injuries result in worse pain

A

False

41
Q

CDC 2010- pain reported over 3 months

A

LBP 28%
Knee 19.5%
Neck 15%

42
Q

Unhealthy PNS

Bombardment of C-fiber activity…

A

Into CNS dorsal horn resulting in permanent changes over time

43
Q

T or F

Receptors on nerves work by opening ion channels (sensors) in the wall of the nerve

A

True

44
Q

Depression screening:
Probability of severe depression decreases from __ to ___ with 1 negative response
And ___% of yes to both questions

A

20% to ~ 5%

50% chance if yes to both

45
Q

CIPA: Congenital Insensitivity to Pain with Anhydrosis

A

Congenital disorder
Don’t feel pain

Frequent injuries/fractures
Most die by 3 y/o
Remaining don’t live to 25

46
Q

FADQ

A

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

47
Q

Death of inhibitory neurons

Consequence

A

Decreased gating from the periphery

48
Q

Weaknesses of Gate theory

A
  1. Ignores psychological/mood
  2. Over-simplified
  3. Premise: neural system is hardwired (research shows plasticity)
49
Q

T or F

Second-order messenger nerves post-synaptic membrane potential (excitement) is dependent on descending modulation

A

True

50
Q

T or F

Descending neurons are always inhibitory

A

False

51
Q

Typical pain neural signature

A
  1. Premotor/Motor cortex
  2. Cingulate cortex
  3. Prefrontal cortex
  4. Amygdala
  5. Sensory cortex
  6. Hypothalamus/Thalamus
  7. Cerebellum
  8. Hippocampus
  9. Spinal cord
52
Q

T or F

In chronic pain, chemicals associated with stress can directly activate danger messenger nerves

A

True

53
Q

Multiple psychological factor screening

A

OMSQ
Orebro MSK screening questionnaire

12 items
Useful to identify work-injured patients at-risk of persistent MSK problems

54
Q

PCS

Cut offs

A

Pain catastrophizing scale

11: 25th percentile
20: 50th percentile
31: 75th percentile

> 50th (20) suspicion of psychological influence
75th (31) consider (+) for psychological influence

55
Q

T or F

The body tells the brain when it is in pain

A

False

56
Q

T or F

Pain only occurs when you are injured or at risk of being injured

A

False

57
Q

Allodynia

A

Pain due to a stimulus that does not normally provoke pain

58
Q

Pain afferents are ___ fibers

A

Slow fibers

A-delta and C fibers

59
Q

If patient is positive on the 2 question depression screen- consider..

A

Full questionnaire option PHQ-9
To assess diagnosis and severity of depression
(Q9 relates to suicide ideation)

60
Q

Cut-off scores for OMPQ

A

<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

61
Q

Central pain

A

Increased responsiveness of nociceptive neurons in the CNS to their normal or sub-threshold afferent input

62
Q

TSK

Cut offs

A

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

63
Q

T or F

In chronic pain, chemicals associated with stress can directly activate danger messenger nerves

A

True

64
Q

T or F

Nerves can adapt by making more ion channels (sensors)

A

True

65
Q

STarT Back

A

Subgroups for Targeted Treatment Back Screening Tool

Developed for back pain to assist GP referral to appropriate mgmt
Psychosocial subscore

66
Q

___ miles of nerves.

Nerves need….

A

45 miles of nerves

Nerves need:
Space
Movement
Blood

67
Q

Pain mechanisms

Input: Neuropathic

A

Ion channel expression

Pain Science (2 decks)

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