Persistent Pain Flashcards
How does the IASP define pain?
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
Does the amount of tissue damage correlate with the amount of pain experienced?
No, it does not. Tissue damage, biomechanics, tissue health, trigger points, and fascia are poor predictors of pain.
What causes pain?
Pain is an output created by the brain after interpreting a complex mix of sensory input. It does not reside in one object or tissue.
Can pain exist without tissue damage?
Yes, the brain can create pain even in the absence of tissue damage.
What defines chronic or persistent pain?
Pain lasting longer than the expected tissue healing time.
What is sensitization in relation to pain?
A quick increase in sensitivity that can be peripheral or central. Central Sensitization is common in persistent pain and involves the spinal cord amplifying pain signals.
How many Canadians reported having chronic pain in 2021?
About 8 million Canadians.
What emotional and psychosocial factors influence chronic pain?
Anxiety, depression, fear avoidance, catastrophizing, expectations, and social support.
How can chronic pain affect someone’s life?
It may lead to depression, poor sleep, fatigue, dependent behavior, disability, and economic cost (estimated at $57 billion in Canada in 2019).
What is the role of the massage therapist in managing chronic pain?
Understand the bio-psycho-social model, build therapeutic relationships, set goals, and encourage movement.
Why is movement important in treating chronic pain?
It has analgesic effects, boosts self-efficacy, and prevents disuse.
What techniques should be avoided in chronic pain states?
Avoid painful or nociceptive techniques like trigger point compression that can sensitize tissue further.
What is the “nocebo effect” and how can it be avoided?
A negative outcome due to suggestion or belief. Avoid pathologizing language and be mindful of word choice.
What are the 5 E’s in treating persistent pain?
• Engage (build partnership)
• Empathize (listen and understand)
• Educate (address understanding)
• Enlist (involve patient in planning)
• End (summarize, set next steps)
What are the 5 R’s of chronic pain treatment?
• Red flags: rule out serious issues
• Reassure: likely nothing serious
• Reconceptualize: educate on pain
• Recalibrate: graded exposure
• Robust: increase movement gradually
What are key points in educating patients about pain?
• Pain is normal and real
• The body has danger sensors, not pain sensors
• Pain is context-dependent
• Learning about pain promotes recovery
• Active strategies help more than passive ones
What is fibromyalgia (FMS)?
A non-inflammatory, non-articular chronic pain disorder with widespread pain, fatigue, poor sleep, and variable symptoms over time.
What causes or contributes to FMS?
Idiopathic, likely CNS-driven, neuroendocrine dysfunction, and a disorder of pain amplification.
Who is most affected by FMS?
Women aged 20–50 (80–90% of cases), with 30% developing symptoms post-trauma or infection.
How is pain in FMS typically described?
Generalized deep muscular aching, throbbing, stabbing, stiffness, and worse in the morning or at rest.
What factors can trigger FMS flare-ups?
Sleep loss, emotional stress, overexertion, injuries, hormonal changes, inactivity, and weather extremes.
What conditions are commonly comorbid with FMS?
Sleep disorders, IBS, headaches, anxiety, depression, and fatigue.
How is FMS treated medically?
First-line is activity/exercise therapy; low-dose antidepressants and other medications may be used. Rule out other conditions.
What is CFS?
A condition with persistent unexplained fatigue lasting ≥6 months, not resolved by rest and significantly reduces activity.
What is the typical demographic affected by CFS?
Women aged 20–50; 3:1 female to male ratio.
What are common symptoms of CFS?
Muscle spasms, migratory pain, headaches, fever, lymph node swelling, sore throat, infections, anxiety, depression, sleep issues, sensitivity to light/heat, postural faults.
How is CFS treated?
No single test; diagnosis of exclusion. Medications (antidepressants, analgesics, muscle relaxants), activity pacing, and support.
What is MPS?
A chronic regional pain disorder with focal trigger points causing referred pain beyond expected healing time.
What are symptoms of MPS?
Deep dull aching, stiffness, muscle weakness, poor coordination, fatigue, disturbed sleep, and mood changes.
How does pain alter movement in MPS?
Affects mood, speed, symmetry, rhythm, ROM, body mechanics, and muscle recruitment.
What are causes/perpetuating factors of MPS?
Muscle overuse, postural/mechanical imbalances, leg length discrepancy, stress, and TrPs.
What is the significance of TrPs in MPS?
Active TrPs may cause severe pain and neuroplastic changes. They may mimic radiculopathy and underlie various chronic pain issues.
What conditions might suggest MPS if chronic pain is present?
Headaches, low back pain, hip pain, jaw pain (dizziness, tinnitus), upper limb/cervical pain (can mimic frozen shoulder, TOS), pelvic pain.
