Pain Types

Question 1

Features of a Somatic (nociceptive) pain type (6)

Answer 1

Back pain usually main problem
Usually a deep aching pain
Back pain can be well localised
Back pain can be sharp and catching
Can refer beyond the back
Referred pain often less severe

Question 2

Neurogenic pain type

Answer 2

Consideration When Referred Pain
Referred pain worse than back pain 
Even absent back pain
More likely to go below the knee
More likely decoupled from back pain

Question 3

Impairment function problems of somatic pain and their subtypes

Answer 3

1. Benign specific pathology
2. Acute severe and Irritable Presentation
3. Mechanical Problems:
   A. impaired mobility
   B. impaired control
   I. Loose
   II. Tight

Question 4

Impairment function problems of Neurogenic Pain

Answer 4

1. Radicular pain only

2. Radicular pain with radiculopathy

Question 5

Other contributing factors to pain presentation

Answer 5

Physiological contributing factors

• tissue health
• Local chemical environment
• neuroimmune changes

Functional contributing factors
o Local
o Remote
o General / lifestyle

Psychosocial contributing factor

• emotional
• cognitive
• behavioural
• social/contextual

Question 6

Features of an Input dominant mechanism (9)

Answer 6

Well defined area of pain
In clear anatomical patterns
Standard history
Appropriate level of irritability for stage
Behaves mechanically
Has a position of ease
Predictable responses to physical loading - makes biomechanical sense
Consistent response to physical loading
Reasonably stable

Question 7

Physical Ax features of a neurogenic problem (17)

Answer 7

Antalgic posture that unloads nerve
Aggravated by position that compress nerve
Aggravated by activities that stretch nerve
Latent and after pain responses to testing
Relief by activities that decompress nerve
Relief with positions that unload stretch
Time dependent changes in symptoms
Pain reproduced on NDT
Positive neural palpation
Possible loss of nerve function
Hypersensitive in referred area
Relevant mechanical impairments
Poor mobility into opening
Poor control of closing
Poor control of tensioning
Remote finding driving closing
Remote findings adding tension

Question 8

Physical findings suggesting an input dominant pain type (6)

Answer 8

Stressing a peripheral structure reproduces the persons pain
Nature and direction of the stress fit in with the history
The sensitivity to testing is reasonable
Stressing other bits does not reproduce the persons pain
Pain is worse when you stress that structure in more provocative positions
Pain is less when you stress that structure in less provocative positions