Prediction and Prognosis in Pain Flashcards
describe what a natural course of pain is vs a clinical course of pain
natural: the course a disease process or health condition can be expected to take without any intervention
clinical: the course a disease process or health condition can be expected to take with a specific intervention
define prognosis and theranosis
prognosis: the anticipated long term end point of a disease or health condition with/without any specific intervention
theranosis: the expected outcome or effect of a specific intervention on this health status in this person at this time (subtype of prognosis)
what should you do if prognosis is good vs poor
what is iatrogenic disability
good: let nature take its course
bad: identify the most important risk factors, intervene as appropriate
giving someone the sense they’re disabled by indicating they need treatment
what are the best predictors of a poor outcome (developing chronic pain)
what are the 3 steps you should take in any clinical encounter
pre existing depression and PTSD symptoms
assess: consider triangulation and radar plot
predict: prognosis, need for intervention, what findings are modifiable and how/by who
treat: choose how to best identify the primary drivers and risk factors, work with the patient to create intervention strategies and milestones
what are considered good outcomes for rehabilitation
is there consensus on a single good outcome
absent/tolerable and manageable symptoms, less interference with important activities/functions, resumption of work or other occupations, observable indicator of physical function are normal
no there is not
what were the top 6 reports of what recovery means to people with neck pain
what is the #1 indicator that a patient has recovered
absent/manageable symptoms, participation in valued life roles, having the physical capacity one ought to have, feeling positive emotions, autonomy and spontaneity, re-establishing a satisfactory sense of self
interpersonal connection (they don’t feel like a burden anymore)
across conditions and largely across outcomes, what are the 3 most likely trajectories we can predict for recovery
most recovery occurs in the first ___ weeks
about 15-35% will recovery quickly and uneventfully
about 20-45% will show some recovery but it will be delayed or incomplete
about 20-40% will show very little recovery and report significant persistent symptoms
first 12 weeks
what are the high confidence risk factors that help predict a poor recovery
high pain intensity (>6/10), high neck related disability, PTSD symptoms, catastrophizing, cold hypersensitivity, mechanical hypersensitivity (distal > local especially when far away from injury site)
what factors have no effect on recovery outcome
what does this tell us
T or F: there is an association between crash details and prognosis
angular deformity of the neck, impact direction, seating position, awareness of collision, head rest in place, older age, vehicle speed
it has more to do with how you react to the collision instead of the collision itself
F
what tools can you use to predict whether or not a patient will develop chronic pain
orebro musculoskeletal pain questionnaire, keele start back tool, traumatic injuries distress scale, clinical prediction rule for whiplash associated disorder
when administering a neck disability index after a whiplash injury, what would lead you to assume they will recover well, have neither a full recovery or chronic symptoms, or develop chronic symptoms
good recovery: score less than 32% and are under 35 yrs old
neither: score 33-39% OR score over 40%, are under 35 yrs old and score less than 6 on the hyperarousal subscale
chronic symptoms: score over 40%, over 35 yrs old, score higher than 6 on the hyperarousal subscale
tools for predicting chronic pain relies heavily on what things
what are tools for predicting chronic pain good at discriminating between
tools for predicting chronic pain rarely provide what
patent reports and cognitions/perceptions
the very high and very low risk groups
clear directions for mechanisms (the why) or treatment targets
are we better at identifying low or high risk individuals with chronic pain screening tools
low
explain the fear avoidance model
injury occurs which causes pain
if there is no fear associated with the pain, there is confrontation and recovery
if catastrophization occurs after pain, it causes fear leading to avoidance and hypervigilance (hyperaware of every symptom) which then causes disuse, depression and disability (leads to pain and catastrophizing to continue in the loop)
what is a limitation of the fear avoidance model
contributes the development of chronic pain to catastrophization, says nothing about social determinants, stigmatizes people who develop chronic pain as weak or misinformed, says people who think right are immune to chronic pain
what does the integrated model of chronic whiplash associated disorder suggest about injury
no one encounters injury in a vacuum, we bring a lot of other factors (either protectors or limitations to recovery) to the trauma which affects the trauma
