Quiz 2 Flashcards
_ is the phenomenon whereby anticipation and expectation of a negative outcome may induce the worsening of a symptom.
NOCEBO
What do anterior cingulate cortex, prefrontal cortex, Thalamus, basal ganglia, insular cortex, amygdala, and periaqueductal grey matter have in common?
They all have mu-opioid receptors
What area of the brain is associated with: recognition/ awareness? Decision making/ thought process? Considered the relay center?
Recognition/ awareness= anterior cingulate cortex (ACC)
Decision making/ thought process= prefrontal cortex (PFC)
Relay center= Thalamus
What area of the brain is responsible for: gut feeling? Emotion/ feeling ‘happy’? Serotonin production?
Gut feeling= insular cortex
Emotion/ feeling happy= amygdala
Serotonin production= periaqueductal grey matter
Morphine, oxycodone (Percocet, OxyContin), and hydrocodone (Vicodin, codeine) are examples of? Can affect more than _, also has an effect on _ and _ _. (Which correspond to which areas of the brain?)
All are examples of ANALGESICS
Can effect more than PAIN, also has an effect on COGNITION (PFC) and MOTOR FUNCTION (BASAL GANGLIA)
Dopamine (D1-5) receptors are found in the _ _, ventral tegmentum, and striatum.
. . . Are found in the BASAL GANGLIA, ventral tegmentum and striatum
Cocaine, ecstasy, amphetamines, and methamphetamines are examples of _ _ _. What is the prescription drug version (NDRI’s) used for? Dopamine agents _ nociception.
. . . Are all examples of DOPAMINE REUPTAKE INHIBITORS
Prescription drug version is NDRI’s (norepinephrine and dopamine reuptake inhibitors) used as anti-depressant (example- Wellbutrin)
Dopamine agents ATTENUATE nociception
In addition to the Basal ganglia, serotonin is also released in the _ _, and _ _.
. . . Serotonin is also released in the BRAIN STEM, and GASTROINTESTINAL TRACT
_ and _ _ _ (Effexor, cymbalta), and _ _ _ _ (selective serotonin reuptake inhibitors) are prescribed for anti-depressants, anti-anxiety, and for chronic pain relief.
SEROTONIN and NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI’s) and SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI’s) are prescribed . . .
In addition to having a patient rate his/ her pain intensity on a scale from 0-10 what additional scaled information might be useful?
How unpleasant/ taxing/ annoying/ debilitating (etc) is your pain?
_ have been found to activate pain modulating networks. What is the is known as?
EXPECTATIONS have been found to . . .
Known as the PLACEBO EFFECT
Where is the reward system of the brain located?
Nucleus accumbens
Placebo analgesia affects pain via both _ of ascending nociceptive pathways and _ of forebrain and limbic pain generating circuits.
Placebo analgesia affects pain via both INHIBITION of ascending nociceptive pathways and MODULATION of forebrain and limbic pain generating circuits.
There are _ _ _ that make up the cortical mechanisms of placebo analgesia.
There are 3 DESCENDING PATHWAYS that make up . . .
What are the stops on the first descending placebo pathway (3)?
APP
- anterior cingulate cortex (ACC)
- prefrontal cortex (PFC)
- periaqueductal grey matter (PAG)
The second descending placebo pathway includes which 5 structures?
D PAIR (order)
- Dorsal horn (5)
- PAG (3)
- Amygdala (2)
- INSULA (1)
- Rostral ventral medulla in the brain stem (4)
Placebo in clinical practice: include _ suggestions about treatment _; _ _ and feel of _ affect patient perception of office competency and ‘buy in’; communicate _ a _ _ _ is being used.
Include POSITIVE suggestions about treatment EFFICACY
OFFICE ENVIRONMENT and feel of TREATMENT affect patient perception of office competency and ‘buy in’.
Communicate WHY a PARTICULAR THERAPEUTIC APPROACH is being used
Placebo in clinical practice: explain _ of _ and set _ _ and _. Sample manual therapy or movement re-education to _ _ of _ and increase -.
Explain EFFECT of EXPECTANCY and set REALISTIC EXPECTATIONS and INTENTIONS
Sample manual therapy or movement re-education to SHOW PROOF of CONCEPT and increase BUY-IN
_ _ is identified around week 12. FMRI studies show that as symptoms increase so does _ _ _.
CHRONIC PAIN is identified around week 12
FMRI studies show that as symptoms increase so does PREFRONTAL CORTEX ACTIVITY
What are the 3 contributing factors to the chronification of pain? If you can affect one, you will?
- emotions
- cognition
- behavior
If you can affect one, you will have an effect on the other 2
_ _ is a common sign in chronic pain patients.
PAIN CATASTROPHISING
What are the 3 subsections of pain catatrophization?
MR. H
- magnification
- rumination/ perseveration
- helplessness
Dependent personality types: compel others to _ _ for major areas of _ _; lack _ _ and experience intense discomfort when _.
Compel others to ASSUME RESPONSIBILITY for major areas of THEIR LIVES
Lack SELF CONFIDENCE and experience intense discomfort when ALONE.
Dependent personality characteristics: experiences high levels of _ and _ by the mere thought of _; are _; filled with _ _ and _.
Experiences high levels of ANXIETY and FEAR by the mere thought of ABANDONMENT
Are INDECISIVE
Filled with SELF DOUBT and INSECURITY
Dependent personality type- PT strategies: _ and ; set _ _ ( steps); set up for _.
EDUCATE and EMPOWER
Set SMALL GOALS (BABY steps)
Set up for SUCCESS
Dependent personality type- PT strategies: maintain _/ _ relationship and avoid _ treatments. Be sure to _, _, and maintain _.
Maintain PROFESSIONALISM/ FORMAL relationship and avoid PASSIVE treatments.
Be sure to REFLECT, LISTEN and maintain BOUNDARIES
What personality type is being described: shy and withdrawn, hypersensitive to criticism and rejection and avoids relationships?
AVOIDANT PERSONALITY TYPE
Avoidant personality types- PT strategies: _ and provide _ feedback; promote -; reinforce exercise _ _ and provide _ steps; try to understand _ _ and be _; _ when needed.
EMPOWER and provide POSITIVE feedback
Promote SELF-EFFICACY
Reinforce exercise GOAL ATTAINMENT and provide BABY steps
Try to understand THEIR FEAR and be PATIENT
REDIRECT when needed
What type of personality type is being described: adamantly insist in having others submit to their way, cannot tolerate making mistakes and may be overwhelmed with anxiety, pre-occupied with perfectionism, and a tendency to perform activities in excess of the ‘norm’?
OBSESSIVE COMPULSIVE personality type
OCD- PT strategies: _ and make it appear as though _ are _ the _; if they perseverate try to _ and _ and _ if necessary; provide _ _ and _
COLLABORATE and make it appear as though THEY Are DRIVING THE DECISIONS
If they perseverate try to REFLECT AND REDIRECT and DISTRACT if necessary
Provide POSITIVE ENCOURAGEMENT and PRAISE
Paranoid personality type characteristics: _ and _ of others; feel _ and that people are _ to _ them; feel that people will _ _ and _ them; view themselves as _, _, _ and _ by others.
SUSPICIOUS and MISTRUSTING of others
Feel VULNERABLE and that people are OUT TO UNDERMINE them
Feel that people with TAKE ADVANTAGE and MANIPULATE them
View themselves as RIGHTEOUS, INNOCENT, NOBLE and MISTREATED by others
Paranoid personality type characteristics: tendency to excessively get _ _; tendency to _ _ of _ and _ your understanding; tendency to be _ of given _ and to _ and _ the practitioner; may be initially _ until something _ occurs.
Tendency to excessively get SECOND OPINIONS
Tendency to ASK LOTS OF QUESTIONS and TEST your understanding
Tendency to be SKEPTICAL of given TREATMENT and to QUESTION AND DOUBT the practioner
May be initially PATRONIZING until something UNEXPECTED occurs
PT strategies for Paranoid personality types: be a _ _ (_/ _everything thoroughly) and remain totally _ and -.
Be a STRAIGHT SHOOTER (DEFINE/ EXPLAIN everything thoroughly) and remain totally NEUTRAL and NON-ADVERSARIAL
What type of personality type is being described: has unstable relations, disturbed identity, love/ hate relationships (extremes), feels powerless and vulnerable in a dangerous world (victim mentality), and views themselves as helpless and inherently unacceptable?
BORDERLINE PERSONALITY DISORDER
Borderline PD characteristics: vacillate between _ and _, tendency to _ passively and do the _; tendency to unexpectedly _ or form _ _; and have a tendency to _ themselves.
Vacillate between AUTONOMY and DEPENDENCE
Tendency to AGREE passively and do the OPPOSITE
Tendency to unexpectedly COMPLAIN or form LITIGATION CHARGES
Have tendency to HURT themselves
With borderline PD types be careful not to be _ _ a _ _, and remain _ and _ in the midst of - _.
Be careful not to be SUCKED INTO a PERSONAL RELATIONSHIP, and remain CALM and UNWAVERING in the midst of TODDLER LIKE BEHAVIOR (tantrums, whining, manipulation)
People with _ _ tend to pay excessive attention to threat-related stimuli and interpret ambiguous stimuli as more threatening.
People with ANXIETY DISORDERS . . .
There are _ _ types of anxiety disorders. Name them.
There are 5 MAJOR TYPES of anxiety disorders (G-POPS)
- generalized anxiety disorder (most common)
- panic disorder
- OCD
- PTSD
- Social phobia
Catastrophizing, brain poisoning, somatosensory amplification and behavioral/ fear avoidance behaviors are all _ _ that facilitate development and maintenance of _ _.
. . . Are all ANXIETY PROCESSES that facilitate development and maintenance of CHRONIC PAIN
What are the 3 parts of the brain/ CNS that contribute to anxiety circuit modulation?
AIM
- amygdala
- insular cortex
- Medial prefrontal cortex (MPFC)
With anxiety the amygdala assigns a _ or _ _
Assigns a POSITIVE or NEGATIVE TRIGGER
The insular cortex affects the processing of how the body feels _ and how it may feel _ the _.
Affects the processing of how the body feels NOW and how it may feel IN THE FUTURE
The Medial PFC _ and _ the need for executive control.
The medial PFC EVALUATES AND PROCESSES the need for executive control.
In patients that have personality disorders the _/ _ of the _ will dictate functionality.
The SEVERITY/ MAGNITUDE of the DISORDER will dictate functionality.
