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CP3 > PNE > Flashcards

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
Q

What is the pain neuromatrix?

A

widespread brain activity associated with pain experience

26
Q

T/F: the way we assess pain can ignite the pain neuromatrix

A

True

27
Q

When assessing pain mechanisms what are the 3 types of pain?

A
  1. Nociceptive
  2. Neuropathic
  3. Central sensitization (CS)
28
Q

Criteria for CS pain

A
  1. perceived pain/disability disproportionate to nature of injury/pathology
  2. diffuse/neuro-anatomically illogical distribution OR hypersensitivity present
29
Q

Widespread Pain Index:

Score suggesting widespread pain

A

7 or greater

30
Q

Central Sensitization Inventory (CSI) score=possible predominant CS paint

A

40

31
Q

T/F: Conventional rehab is often successful in the chronic pain population

A

False

32
Q

PNE:

How to communicate the results of the physical exam

A
  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
Q

PNE:

Nociceptive education

A

explain source of nociception and role of the brain (pain matrix)

34
Q

PNE:

neuropathic education

A

explain pain neuroscience underlying neuropathic pain mechanisms

35
Q

PNE:

central sensitization pt edu

A

explain pain neuroscience underlying central sensitization pain

36
Q

What are some ways to help educate regarding the nature of the problem

A
  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
Q

How is PNE typically billed

A

Neuro Re-Ed

Make sure to ask billing department at your facility

38
Q

Intervention:

What are the 4 pillars of PNE+

A

pain education
aerobic exercise
sleep hygiene
goal setting

39
Q

PNE principles with pain education:

A
  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
Q

PNE:

Why is it important to encourage physical activity as early as possible?

A

Benefits of physical activity on chronic MSK pain are widely accepted

41
Q

examples of frequent reassurance that becoming active gradually is safe

A

“sore but safe”

“hurt does not equal harm”

42
Q

T/F: Aerobic exercise is superior to resistance in chronic conditions

A

False

difference is unclear

43
Q

PNE:

Exercise induced changes include

A
  1. reduced fear, anxiety, and catastrophization
  2. improved self-efficacy
  3. exercise-induced analgesia
  4. positive functional and structural adaptations in the brain
44
Q

Biopsychosocial approach to exercise

A
  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
Q

PNE:

Recommended to provide _ exercises to do at home including _

A

4-5 easy exercises:

  • Large ROM movements
  • Neurodynamics
  • Relaxation or diaphragmatic breathing exercises
46
Q

PNE:

Principles of exercise prescription

A
  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
Q

PNE Mode of exercise:

Aerobic Exercise

A
  1. 20-60 minutes
  2. 2 or more/week x 6 weeks
  3. “turn down the pain volume or dampen pain response”
48
Q

PNE Mode of exercise:

Resistance

A
  1. Familiarize patient with the exercise

2. Engaging non-painful body parts can have positive impact on pain

49
Q

PNE Mode of exercise:

Land based

A

may facilitate greater improvement in muscle function

50
Q

PNE Mode of exercise:

Aquatic based

A

may be necessary for individuals with very poor functional tolerance or heightened pain/distress

ultimate goal-land based

51
Q

Effects of lack of sleep

A
  1. increased pain
  2. obesity
  3. depression
  4. increased risk for cancer
52
Q

PNE:

Goal setting

A
  • list of 5 goals
  • likely the patient will use vague goals
  • help patient develop measurable and functional goals
53
Q

How to help the patient develop measurable and functional goals

A
  1. break goal down into small, manageable pieces
  2. use concept of pacing
  3. set timeframes and discuss barriers
54
Q

Recommended speed for L/R discrimination cards:

A

Neck and back: 1.6 +/- 0.5 seconds

Hands, feet, shoulders, knees: 2 +/- 0.5 seconds

55
Q

Components of Explicit Motor Imagery

A
  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
Q

Mirror Therapy

A
  1. Start with exercises involving little-no movement.

2. gradually increase difficulty in front of and behind mirror

57
Q

What order do you have to take with graded motor imaging?

A
  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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