Physical Agent Modalities and Pain Flashcards
When interviewing a person who is in pain, what parameters of that pain do you want to record?
Are you hurting? Where does it hurt? Can you describe the pain? Does it change when you move? Taking anything for the pain? Assess intensity scale 0-10
What kind of pain does this describe? Sharp, localized, rapid onset, tissue damage (can use modalities)
Acute
What kind of pain does this describe? dull, ache, poorly localized, cause unspecified, of long duration
Chronic
What kind of pain does this describe? felt at site away from original source
Referred
Describe how pain interferes with everyday life activities.
- ⅔ of people who experience chronic pain cannot perform routine occupations
- People in pain are less productive at work (and lose income if they cannot work)
- Pain can affect performance/ability to participate in ALL occupations across all settings, and can cause negative emotions (suffering)
As an OT, what can you do to help a person better manage or reduce her/his pain?
Aside from PAMs, OTs can: always ask about pain and be an advocate for patients who are in pain, educate the patient about energy conservation, educate the patient on body mechanics, do activity analysis to determine what specifically is causing the pain, work with the patient on alternative pain management techniques (like stretching and mindfulness).
Name some pain scales
- Brief Pain Inventory: Long and short forms; 0-10 scale with a 24 hour recall period measures how much your pain interferes with daily activities
- Pain Diary: 7 day log…you rate your pain from 0-10 every hour
- Multidimensional Pain Inventory: 7 page questionnaire
- Pain Behavior Scale: tracks severity of chronic pain over time
What are the risks of pain medications?
You can develop a physical dependence as well as your body can build a tolerance
What are the three stages of wound healing?
- inflammatory
- proliferative
- remodeling
What stage of wound healing does this describe? immediate
inflammatory phase
What stage of wound healing does this describe? 2nd week; fiber-plastic phase
proliferative phase
What stage of wound healing does this describe? 1 year or longer; maturation
remodeling phase
Which of the four therapeutic modalities used in our lab is appropriate for the inflammatory phase?
- Cryotherapy - reduces pressure on tissue
- Pulsed Ultrasound - allows tissue to cool before pulsing again (patient shouldn’t feel heat. Aids in inflammation/pain/edema management
- TENS
Which of the four therapeutic modalities used in our lab is appropriate for the proliferative phase?
- Paraffin - encourages blood vessels to open up, moving into the beginning of the healing phase (achey pain good with heat)
- Continuous Ultrasound - warming effect and tissue permeability effect. Improves circulation, aids in tissue healing
- TENS
Which of the four therapeutic modalities used in our lab is appropriate for the remodeling phase?
- Continuous Ultrasound - deep heating helps with tissue healing, extensibility of collagen tissue
- TENS - addresses chronic pain the best
What are the primary indications for cryotherapy?
acute injury & inflammation; edema control; arthritic flare-up; acute bursitis & tendonitis; spasticity; pain related to muscle spasm
What are the contraindications for cryotherapy?
patients with impaired circulation of cold sensitivity; wounds 2-3 weeks post-injury; pregnancy
precautions: monitor BP & skin condition; document treatment parameters
What are the contraindications for paraffin?
pacemaker; metastasis; fever; acute inflammation; acute hemorrhage; peripheral vascular disease; lack of sensation
What are the indications for paraffin?
bony prominences; uneven contours; skin softening; even heat across part being treated; esp. good for arthritis
What are the contraindications for TENS?
area over carotid sinus; chest of those with cardiac disease; pacemakers; epilepsy or neurologic impairment- not over head or neck; trunk of pregnant woman; eyes; unable to communicate pain
What are the indications for TENS?
acute, localized pain; chronic pain; phantom limb pain; postoperative pain; shingles; before painful treatments to elevate pain threshold
What are the contraindications for ultrasound?
Decreased sensation/circulation; Never during pregnancy/over reproductive organs (or eyes); area of pacemaker; CNS tissue (and CSF); malignancy or tumors; over epiphyseal plates of children; thrombophlebitis
precautions: acute inflammation; fx; breast implants; pt. w/cognitive/language/or sensory limitations
What are the indications for ultrasound?
thermal (continuous): pain, chronic inflammation, increase ROM & circulation, decrease muscle spasm/ jt. stiffness, edema, facilitate tissue healing
mechanical (pulsed): tissue repair (fx), wound healing, acute injury/inflammation
What are the four stages of numbing in cryotherapy?
1) Intense feeling of cold
2) Stinging/burning sensation
3) Dull aching
4) Numbness
What does RICE mean and when is it appropriate?
rest, ice, compression, elevation; during first 6-24 hours after acute injury
In treating rheumatoid arthritis, when is paraffin contraindicated?
During an acute inflammatory attack; vigorous dosages of heat may facilitate proteins that act as catalysts to increase enzyme activity, exacerbating joint inflammation
Why do we change “modes” when using TENS?
to prevent acclimation to the stimulus
How do you calculate the appropriate intensity for TENS with a particular person?
Slowly increase until they report a light tingle
What is the gate control theory of TENS?
the stimulation of nociceptors can interfere with the relay of pain sensation to the brain; non-painful TENS input “closes the gate” for painful input
What is the opiate theory of TENS?
TENS causes the release of the body’s natural opiates from the pituitary gland and spinal cord (endorphins and enkephalins, respectively) to reduce pain sensation
What is the vasodilation theory of TENS?
TENS can cause dilation of the blood vessels in the area, which can provide increased blood flow to the affected areas around the painful trigger points
What is the acupuncture theory of TENS?
certain specific points on the body have been linked to experience of pain syndromes; TENS stimulation of those areas can decrease perception of pain
In treating pain with TENS, why do you NOT want to generate a muscle twitch?
It can lead to a muscle spasm, which is bad for pain management
In lay terms, what is ultrasound and how does it promote wound healing and pain relief?
good question!
Ultrasound: how often a wave comes out of the machine (depth/speed)
frequency
Ultrasound: “loudness”; affects warmth
intensity
T/F: Ultrasound: 3 MHz: fast, shallow/superficial
True
T/F: 1 MHz: low, slow, deep
True
T/F: In ultrasound, the smaller the MHz, the deeper the wave goes?
True- 1mhz goes deeper than 3
After providing an Ultrasound therapy session, what treatment parameters do you record so that another therapist may repeat the treatment tomorrow?
Location of application, frequency, intensity in W/Cm2, pulsed or continuous, transducer size, time applied, number of treatments per week
After providing a cryotherapy session, what treatment parameters do you record so that another therapist may repeat the treatment tomorrow?
Location of application, time applied, reason for treatment, recommendations for number of treatments per week (usually a self-applied modality)
After providing an paraffin bath therapy session, what treatment parameters do you record so that another therapist may repeat the treatment tomorrow?
Location of application (may be useful to note until what point - i.e. “on R hand to wrist”), number of times dipped, time applied, temperature of bath, reason for treatment
After providing an TENS therapy session, what treatment parameters do you record so that another therapist may repeat the treatment tomorrow?
Pain scale findings before & after treatment, sensation reports during treatment, location of application (may use drawings to show placement of electrodes) & type of stimulation, mode, pulse, frequency, intensity & duration of treatment
