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PNE Flashcards

1
Q

According to the biopsychosocial model primary pathology often causes:

A
  1. Fear of movement
  2. pain catastrophizing
  3. nervous system sensitization
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2
Q

T/F: Treatment for chronic pain incorporating the biopsychosocial model viewed as the most effective approach

A

True

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3
Q

What may be a result of addressing pain alleviation and disability using the Biomedical Model?

A

Increased fear, anxiety, and stress

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4
Q

What are some psychosocial considerations for individuals with chronic pain?

A
  1. likely to have seen several med practicitoners
  2. likely to have at least 1 neg encounter
  3. pain may have been discounted
  4. may have heard several explanations for their p!
  5. depression is common
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5
Q

How should you conduct a skillful interview?

A

aim questions to gain better understanding of patient’s experiences, suffering, and beliefs

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6
Q

what are the key issues from the PNE perspective?

A
  1. create a therapeutic alliance
  2. Screen patient for red flags
  3. Establish psychosocial barriers to improvement (yellow flags)
  4. Assess Pain Mechanisms
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7
Q

What intake forms can be utilized for pain

A 
ODI
NDI
DASH
LEFS
FAAM
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8
Q

What outcome measures address fear?

A
  1. Fear avoidance brief questionnaire (FABQ)
  2. Pain catastrophization scale
  3. Tampa Scale for Kinesiophobia
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9
Q

What is considered a High score for the FABQw and FABQpa?

A

FABQw: 34
FABQpa: 14

high scores indicate increased fear and avoidance

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10
Q

What are the 3 dimensions of the pain catastrophization scale (PCS)?

A
  1. Rumination
  2. Magnification
  3. Helplessness
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11
Q

What score on the PCS indicates clinically relevant level of catastrophizing?

A

30 or greater

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12
Q

What score on the Tampa Scale indicates fear of movement

A

37 or greater

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13
Q

Red/Yellow Flags:

Saddle Anesthesia

A

Red

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14
Q

Red/Yellow Flags:

Loss of bowel/bladder function

A

Red

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15
Q

Red/Yellow Flags:

Depression

A

Yellow

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16
Q

Red/Yellow Flags:

Anxiety

A

Yellow

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17
Q

Red/Yellow Flags:

Catastrophization

A

Yellow

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18
Q

Red/Yellow Flags:

night pain

A

Red

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19
Q

Red/Yellow Flags:

unexplained weight loss

A

Red

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20
Q

What should you do if you find a red flag

A

Requires immediate attention:

  • pursue further screening
  • making appropriate referral
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21
Q

Red/Yellow Flags:

Considered to be main contributors to pain and disability

A

Yellow

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22
Q

What PHQ score indicates depression?

A

PHQ9: 10 or greater

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23
Q

What score indicates clinically significant symptoms of anxiety on the STAI?

A

39 or higher

54 or higher for older adults

24
Q

What are the components of the physical exam in the PNE approach?

A
  1. Focus on global, functional movements
  2. discuss results without using inflated, fear-inducing words
  3. focus on enhancing therapeutic relatioinship
  4. include assessment of general fitness
  5. Include NS tests if appropriate:
    - graphestheisa, 2 pt discrimination, etc
25
What is the pain neuromatrix?
widespread brain activity associated with pain experience
26
T/F: the way we assess pain can ignite the pain neuromatrix
True
27
When assessing pain mechanisms what are the 3 types of pain?
1. Nociceptive 2. Neuropathic 3. Central sensitization (CS)
28
Criteria for CS pain
1. perceived pain/disability disproportionate to nature of injury/pathology 2. diffuse/neuro-anatomically illogical distribution OR hypersensitivity present
29
Widespread Pain Index: | Score suggesting widespread pain
7 or greater
30
Central Sensitization Inventory (CSI) score=possible predominant CS paint
40
31
T/F: Conventional rehab is often successful in the chronic pain population
False
32
PNE: | How to communicate the results of the physical exam
1. describe in terms patient can understand avoiding biomedical terms 2. avoid terminology that increases fear and anxiety 3. establish prognosis and set realistic expectations
33
PNE: | Nociceptive education
explain source of nociception and role of the brain (pain matrix)
34
PNE: | neuropathic education
explain pain neuroscience underlying neuropathic pain mechanisms
35
PNE: | central sensitization pt edu
explain pain neuroscience underlying central sensitization pain
36
What are some ways to help educate regarding the nature of the problem
1. using metaphors, examples, and pictures - alarm system example 2. shift conceptualization of pain from marker of pathology to need to protect body 3. reconceptualize pain experience
37
How is PNE typically billed
Neuro Re-Ed | Make sure to ask billing department at your facility
38
Intervention: | What are the 4 pillars of PNE+
pain education aerobic exercise sleep hygiene goal setting
39
PNE principles with pain education:
1. pain is an output of the brain (brain's best guess for protection) 2. pain not always an indicator of tissue damage 3. amount of pain doesn't always equal the amount of damage 4. in chronic pain your brain believes you are in danger and need protecting
40
PNE: | Why is it important to encourage physical activity as early as possible?
Benefits of physical activity on chronic MSK pain are widely accepted
41
examples of frequent reassurance that becoming active gradually is safe
"sore but safe" | "hurt does not equal harm"
42
T/F: Aerobic exercise is superior to resistance in chronic conditions
False | difference is unclear
43
PNE: | Exercise induced changes include
1. reduced fear, anxiety, and catastrophization 2. improved self-efficacy 3. exercise-induced analgesia 4. positive functional and structural adaptations in the brain
44
Biopsychosocial approach to exercise
1. Must be perceived as safe and meaningful 2. may need to temporarily stop or modify specific activities per patient tolerance 3. take caution not to draw frequent attention to pain
45
PNE: | Recommended to provide _ exercises to do at home including _
4-5 easy exercises: - Large ROM movements - Neurodynamics - Relaxation or diaphragmatic breathing exercises
46
PNE: | Principles of exercise prescription
1. provide patient with treatment expectation 2. establish baseline of activity within first session 3. discuss activity pacing 4. continue to provide pt edu 5. utilize activity tracker to monitor activity
47
PNE Mode of exercise: | Aerobic Exercise
1. 20-60 minutes 2. 2 or more/week x 6 weeks 3. "turn down the pain volume or dampen pain response"
48
PNE Mode of exercise: | Resistance
1. Familiarize patient with the exercise | 2. Engaging non-painful body parts can have positive impact on pain
49
PNE Mode of exercise: | Land based
may facilitate greater improvement in muscle function
50
PNE Mode of exercise: | Aquatic based
may be necessary for individuals with very poor functional tolerance or heightened pain/distress ultimate goal-land based
51
Effects of lack of sleep
1. increased pain 2. obesity 3. depression 4. increased risk for cancer
52
PNE: | Goal setting
- list of 5 goals - likely the patient will use vague goals - help patient develop measurable and functional goals
53
How to help the patient develop measurable and functional goals
1. break goal down into small, manageable pieces 2. use concept of pacing 3. set timeframes and discuss barriers
54
Recommended speed for L/R discrimination cards:
Neck and back: 1.6 +/- 0.5 seconds | Hands, feet, shoulders, knees: 2 +/- 0.5 seconds
55
Components of Explicit Motor Imagery
1. Time to perform or imagine the task is roughly the same 2. Important to perform in as many different places as possible 3. Begin with unaffected area and work toward affected 4. Goal to visualize yourself but you can visualize someone else movement if it is too difficult
56
Mirror Therapy
1. Start with exercises involving little-no movement. | 2. gradually increase difficulty in front of and behind mirror
57
What order do you have to take with graded motor imaging?
1. Motor/fucntional empathy (watching) 2. Implicit Motor Imagery (L/R ) 3. Explicit Motor Imagery 4. Mirror Therapy 5. Motor/Functional exposure 6. Occupational/higher function exposure

CP3 (7 decks)

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