PNE with Cognitive Functional Therapy & Interventions Flashcards
What is chronic widespread pain (CWP)
- Long lasting pain in multiple body regions associated with other physical symptoms such as fatigue, concentration problems, & psychologic distress
- CWP is a primary symptom in Fibromyalgia & other chronic pain disorders
What are the mechanisms of chronic widespread pain
- Central sensitization
- Temporal summation or wind-up
- Endogenous pain modulatory systems
Describe the mature organism model that helps us understand pain
- Perception of input
- “Scrutinized” by the Brain (interpretation past experience)
- Output = Response as behavior
- Pain response can be multiple systems
Describe the downward spiral
- Negative experience
- Suppressed emotions
- Repetitive negative thinking (rumination)
- Physical distress
- Avoidance and unhelpful behavior
- Depression (can substitute depression with physical activity, pain, weakness, fatigue) spirals out of control
Describe chronic primary pain classification
- Pain in one or more anatomical regions that persists or recurs for longer than 3 mo
- Associated with significant emotional distress or functional disability (interference with activities of daily life & participation in social roles) and that cannot be better accounted for by another chronic pain condition
Describe chronic secondary pain classification
- Chronic secondary pain syndromes are linked to other diseases as the underlying cause, for which pain may initially be regarded as a symptom
Lists the prognostic factors that contribute to chronic pain
- Social determinants of health: SES, education, workplace
- Physiological factors: sleep hygiene, substance (Opioid, Tobacco, ETOH), sedentary lifestyle
- Psychological factors: history of physical/emotional abuse, adverse childhood experiences, post traumatic stress
What are the strengths of cognitive functional therapy (CFT)
- Helps clinicians explore the multidimensional nature of disabling LBP through the context of the individual
A cognitive functional therapy (CFT) evaluation for each individual assesses what modifiable/non-modifiable factors
- Modifiable: cognitive, emotional, physical (load), loading demands, & lifestyle
- Non-modifiable: pathoanatomy, social, sensory. & health
Pain levels are directly proportional to the amount of tissue damage (True/False)
- False
What are the fear avoidance classifications
- Learned pain avoider
- Misinformed avoider
- Affective avoider
Describe a learned pain avoider
- Lower fear reinforced by past experience
- Pain is simply something to avoid
- Choose to avoid potential pain causing activity
Describe a misinformed avoider
- Moderate fear reinforced by others (HC providers)
- Pain indicates harm
- Received poor advice & thus avoid potential activity
Describe an affective avoider
- High irrational & distorted fears
- Catastrophic thinking
- Profound pain inhibitions for all activities
Describe protective & adaptive pain related functional behaviors
- In response to acute tissue injury or response to overuse
- Eg: brief tendinitis because of overload reduces the muscle tendon use until it can adapt
Describe disproportionate & maladaptive pain related functional behaviors
- Pain remains after the initial inflammation subsides that can be linked to pain related fear, distress, degree of tissue sensitivity, and altered body perception
To make sense of the pains a reflective process to help the patient to identify the protective/resilience type factors including
- Connections between factors (dimensions0
- Reflect upon events that challenged their pain beliefs
- Thought viruses
- Danger and safety
What are Waddell’s Non-Organic signs of pain
- Superficial and non-anatomic tenderness
- axial loading and acetabular rotation simulation
- Distraction (ex: SLR supine vs. sitting knee extension)
- Regional sensory disturbance and weakness
- Overreaction
What does SEGUE stand for
- Set the stage: creating a comfortable environment & establishing trust with patients, making them feel respected & cared for
- Elicit information: guiding pts to actively share their medical history, symptoms, including the duration of illness, location of pain, & nature of symptoms among others
- Give info: presenting dx results, disease characteristics, tx plans, & other relevant info to pts in easily understandable language
- Understand the pt’s perspective: they perspective, beliefs, & attitudes regarding the disease
- End the encounter: summarize the discussion, confirm the next steps & action plans with the pt
What is the literature shift for diagnosis of Fibromyalgia
- Inflammatory response
- Muscle response
- Dopamine dysfunction
- Abnormal serotonin regulation
- Noradrenaline dysfunction
- NOW: Neuro-Immune-Endorcrine
Criteria for diagnosing Fibromyalgia must meet 3 of these
- Widespread pain index >7 and symptom severity scale (SSS) >5
- Generalized pain (4 of 5 regions) Blue ovals
- Symptoms >3 mo
- Exclude other Dx
Symptoms of Fibromyalgia
- Widespread pain
- Joint stiffness
- Fatigue
- Persistent pain
- Sleep disturbance
- Depression
- Mental fatigue
- Short term memory loss
- Sensitized GI system
- Anxiety
- Social impact
- Functional impact
- Sexual dysfunction
- Headaches
What conditions mimic Fibromyalgia
- Chronic fatigue syndrome (AKA Myalgic Encephalomyelitis)
- Chronic Lyme disease
- Irritable bowel syndrome
- CRPS
- Restless leg syndrome
- POTS
- Non-Celiac gluten sensitivity
