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Pain Science > Pain Science Test 2 > Flashcards

Pain Science Test 2 Flashcards

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1
Q

MPQ

A

McGill pain questionnaire

Quantitative profile of pain:
Sensory-discriminative
Motivational-affective
Cognitive-evaluative

Components: diag, meds, pain hy, present pain pattern, accompanying symptoms, modifying factors, effects of pain, list of words

Word list: 102 words

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2
Q

Expectation

A

Include expectation in clinical decision making process

Maximize expectation (“This intervention is known to significantly reduce pain in some patients”)

Be aware of unrealistic expectations- maximize realistic expectations

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3
Q

OSA (obstructive sleep apnea)

A

Recurrent episodes of upper airway blockage during sleep which leads to decreased oxygen saturation and increased effort to breathe

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4
Q

TSK

A

Kinesiophobia measure

Total score range 17-68
Higher score = higher fear

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5
Q

The chosen intervention is ____ why patients with pain respond to treatment

A

Just one factor in why

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6
Q

BPI

A

Brief pain inventory

Initially derived for cancer patients receiving palliative care
Has been validated for non-cancer patients (chronic pain, LBP, OA)

Quadruple NPRS; relief w/ meds, pain interference with ___ (activity, mood, sleep, work, relationships, etc); pain language; duration of pain; open ended descriptions; somatization

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7
Q

A neural signal is activated whenever…

A

The brain perceives a threat

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8
Q

FABQ

A

Screen pt w/ LBP for potential for long term disability

FABQ-PA > 15
FABQ-W > 22/29/34
High risk prolonged disability

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9
Q

Therapist contextual factors

A

Clinical equipoise-
Lack of preference or uncertainty for a treatment (lack of equipoise can impact outcome)

Good for research to not introduce bias, but in the clinic
you want.

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10
Q

Therapeutic alliance

A 
Warm, friendly manner 
Active listening 
Empathy 
Periods of thoughtful silence 
Communication of confidence and positive expectation
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11
Q

Peripheral neurogenic symptoms and sign clusters

A

Indicate individuals w/ these features are 150x more likely to accurately predict a clinical classification

Pain in dermatomal or cutaneous distribution
Positive neurodynamic tests and palpation (mechanical tests)
History of nerve pathology or compromise

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12
Q

6 clinical measures of pain

A
  1. VAS (visual analogue cale)
  2. NPRS (numeric pain rating scale)
  3. Body diagram
  4. Brief pain inventory
  5. McGill pain questionnaire
  6. PPT (pain pressure threshold)
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13
Q

“It sounds like you are frustrated with…”
“So you are angry about the lack of support you are getting…”
Are examples of

A

Reflective “leads”

Part of active listening

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14
Q

Patient educated on the concept of the nervous system as the body’s alarm system, and the role of nociception to warn the body of danger. Peripheral nerve sensitization, hyperalgesia and allodynia were explained using metaphors to promote deep learning

A

Sensitive nerves

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15
Q

Quota-based restoration of function regardless of symptoms

A

Graded activity

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16
Q

Combined contextual factors

A

Therapeutic alliance

Collaboration, warmth and support between therapist and patient

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17
Q

Patient was educated regarding endogenous mechanisms and strategies to increase the brain’s production of chemicals to decrease pain, such as aerobic exercise and improved pain knowledge. The concepts of pacing, graded exposure, “sore but safe,” and “hurt does not equal harm were discussed. Sleep hygiene and diaphragmatic breathing topics were introduced to help calm the nervous system and reduce stress.

A

Calming sensitive nerves

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18
Q

Quantitative sensory testing

A

Multidimensional testing paradigm including….

PPT 
Mechanical detection threshold 
Thermal pain threshold 
Vibration perception threshold 
2 point discrimination
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19
Q

NPRS

A

Numeric pain rating scale
11 point Likert scale

Chronic pain patients prefer NPRS
But- chronic LBP and knee OA found NPRS inadequate

MCID (2: LBP; 3 points or 27% reduction)

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20
Q

CSI

A

25 questions 0-4 points each

> = 40 indicative of central sensitization

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21
Q

3 important factors that influence our perception of pain

A

Memory
Hyperviligance
Catastrophization

22
Q

Patient contextual factors

A

Expectation

Preference-
patients desire information; don’t necessarily desire a role in the clinical decision making process

23
Q

Nociceptive symptom and examination clusters

A

Indicate individuals w/ these features are 100x more likely to accurately predict a clinical classification

Proportionate pain
AGGs and EASEs
Pain : intermittent sharp, dull ache, or throb at rest
No night pain, dysesthesia, burning, shooting or electric symptoms

24
Q

Bottom-up vs Top-down approach to pain

A

Bottom-up
Change tissues/unload tissues
Alter environment somewhat
Reduce threat and brain produces less pain
Most traditionally used of therapy
Ex: TENS, manual therapy, othodics, pool therapy

Top-down
Brain used to alter the experience
Ex: education

25
Q

Nocebo

A

Opposite of placebo
Negative expectations = negative outcomes
People given a placebo drug will complain about the exact same side effects that they were warned about.

26
Q

VAS

A

Visual analogue scale

Single or multiple item scale (current, best, worst…)

MCID

27
Q

MPQ- short form

A

McGill pain questionnaire- short form

15 words
Each rated 0-3 (0=none, 3=severe)

28
Q

Central sensitization symptoms and sign clusters

A

Indicate individuals w/ these features are 486x more likely to accurately predict a clinical classification

Disproportionate pain
Disproportionate AGG and EASE
Diffuse palpation tenderness
Psychosocial issues (fear avoidance and pain catastrophization)

29
Q

The majority of chronic MSK pain cases are characterized by _____. More specifically ____.

A

Alterations in central nervous system processing
More specifically the responsiveness of central neurons is augmented, resulting in a pathophysiological state corresponding to central sensitization, characterized by generalized or widespread hypersensitivity.

30
Q

RLS (restless leg syndrome)

A

A neurological condition characterized by a persistent and overwhelming urge to move the legs while resting and typically presents with concomitant complaints of burning, itching, throbbing, or other unpleasant sensations. Movement typically provides temporary relief

31
Q

Ideal time to schedule chronic pain patients

A

Mid-morning through early afternoon
Clinic usually quietest and cortisol levels higher (chronic pain patients often have difficulty with focus and concentration- so cortisol high gives you their most aroused state where concentration/focus likely highest, but as levels starting up drop not too overstimulated)

32
Q

BPI- short form

A

Ideal for clinical practice

Quadruple NPRS 
Relief w/ meds
Pain interface with-
General activity 
Mood
Walking 
Work
Relationships 
Sleep 
Enjoyment of life
33
Q

Chronic insomnia

A

Difficulty falling asleep, maintaining sleep, or waking up too early at least 3 nights per week for the past 3 months

34
Q

PCS

A

13-item 5 point scale
Higher score = higher catastrophization

18 is median for healthy
> 30 clinically relevant catastrophization

35
Q

“Why do patients get better?”

A
  1. Treatment specific effects
  2. Factors unrelated to treatment (natural hy, regression to the mean, repeated measuring)
  3. Preliminary elements (improvement after scheduling, providing diag prior to treatment onset)
  4. Non-specific factors (patient provider relationship, expectations, practice ambience)
36
Q

Merle SBST

A

9-item “agree” or “disagree”/ “not at all” “extremely”
Established predictors of disabling LBP

OA score (1-9) used to separate into low (3 or les) and medium (4 or more) risk subgroups
Distress subscale (5-9) to separate into medium (3 or less) and high risk (4 or more)
Total > 4
5-9 > 4

37
Q

PPT

A

Pressure pain threshold

Algometer or dolorimeter
Normally average of 3

Lower PPT inversely correlated with higher pain

38
Q

3 pain mechanisms

A

Nociceptive
Peripheral neurogenic
Central sensitization

39
Q

TNE

A

Therapeutic neuroscience education

40
Q

Structured communication

SBAR

A

Situation
Background
Assessment
Recommendation

Usually referring back to primary physician

41
Q

Pain is not isolated to sensory input (vs nociception)

Pain is output of the brain that incorporates…

A 
Expectations
Knowledge 
Prior history/experiences 
Emotional state 
Fear 
Location/setting
42
Q

Patient educated regarding spreading pain symptoms, and taught that feeling pain in adjacent areas of the body does not indicate definite tissue injury. Hyperalgesia, immune responses and central sensitization topics were introduced using metaphors to promote deep learning

A

Spreading pain

43
Q

Top 5 factors tied to success

A
  1. Listening to patient
  2. Spending time with the patient
  3. Patient developing trust
  4. Thorough interview
  5. Thorough physical exam
44
Q

Turning down the alarm system therapeutically

A 
TNE/PNE
Aerobic exercise 
Manual therapy 
Breathing, relaxation, meditation 
Modalities 
Etc..
45
Q

Patient introduced to the topic of pain neuroscience education and improving knowledge of how pain works to promote improved recovery and rehabilitation. Current knowledge and understanding of patient on pain related topics was explored to create baseline

A

PNE intro (pain knowledge)

46
Q

Pre-op TNE for lumbar radiculopathy - Multicenter RCT

A

The group with TNE/PNE at 1 year follow up: better results for pain (back and leg), catastrophization, fear avoidance, pain knowledge, satisfaction with surgery, 42% healthcare savings

47
Q

Establishing framework with patient

A 
Tell patient what to expect:
History 
Examination 
Discussion of the diagnosis/prognosis 
Joint decision about the course of therapy 
Begin with compassion/caring 
Listen
48
Q

Patient educated on the concept of neuroplasticity, and how factors such as temperature, stress, movement, immunity and blood flow affect pain via ion channel expression. Instruction provided regarded homeostasis/ion channel balance disruption might occur based on what your brain thinks is needed for survival

A

Nerve sensors

49
Q

Preventing nocebo

A

Frame the instruction

40% get a sore arm
OR
60% do not have a problem with this side effect

You will feel a bee sting
OR
(the anesthetic will) numb the area so that you will be comfortable

50
Q

Gradual resumption of feared activities

A

Graded exposure

Pain Science (2 decks)

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