Teaching people about pain Flashcards
where does pain come from/ where it is produced ?
- the brain
- pain comes form the brain and is based on the perception of a threat
- pain is a multiple system output activated by a individual’s unique pain neural signature
- neural pain signature is activated when the brain perceives a threat
Can we alter the pain experience ?
yes
we can alter the info that goes into the brain and potentially alter the pain experience
can you have pain and not know about it ?
no
What are examples of threats that the brain can perceive as a threat?
job environment and fear
traditionally, how was pain mgmt’d?
the bottom up experience, where we change the tissues to alter pain by a AD, orthotic or massage
- this was heavily based on the pain gate theory
- tens and e-stim used o change the info received by the brain to decrease and decrease pain
what is a top down approach for pain mgmt?
- understanding that pain comes from the brain, and has peripheral effects instead of pain being mgmt’s from the “bottom” at a tissue level.
- we can make the brain smarter
what is a wet brain?
a brain that sends out chemical such as opiods and endorphins to pain instead of inflammatory chemicals in response to pain
- stubbing your toe and not wanting to make a scene of it is done with a wet brain
what is top down education
pain is produced in the brain
- altering info that the brain gets can alter the pain experience
- we can educate on these topics
Traditional education models include what types of models/ details ?
- biomedical model: these examples below have limited efficacy to decrease on/disability and may INCREASE fear
- anatomical models- traumatizing
- lifting techniques- abdominal bracing ect, teaches people to be VERY cautious with activity which leads to avoidance
- staircase model; diagram of how much force is transmitted in diff positions, less F with resting and most F associated with lifting. Places bias on resting for LBP recovery.
True or false: People in pain want to know more about pain…NOT anatomy, biomechanics or patho-anatomy
true
- anatomy alone does not explain complex pain
does research support therapeutic neuroscience education (TNE) ?
yes, for chronic MSK disorders
-explaining to patients their pain experience from a biological and physiological perspective of how the nervous system/ brain’s processes pain allow patients to move better, exercise better, think different about pain, push further into pain, etc
how can TNE be delivered ?
by PTs, 30 min increments are enough, but sessions can last 30-60mins 1-1 format or in a group -prepped pictures - metaphors - hand drawings - Q/A workbook - Neurophys workbook
Should TNE have adjacent treatment?
yes •Manual therapy including spinal mobilization and manipulation •Soft tissue treatment/massage •Neural tissue mobilisation •Spinal stabilisation exercises •Home exercises •None (neuroscience education only) •Circuit training •Aerobic exercis
what are topics covered in TNE
- Neurophysiology of pain
- No reference to anatomical or patho-anatomical models
- No discussion of emotional or behavioral aspects to pain •Nociception and nociceptive pathways
- Neurones
- Synapses
- Action potential
- Spinal inhibition and facilitation
- Peripheral sensitization •Central sensitization •Plasticity of the nervous system
how do nerves work like an alarm system?
400 individual nerves that are all connected for about 45 miles
- NS works like alarm
- NS has electricity- Electricty can go up or down adn can “wake up” with pain- like stepping on a nail.
- persistent pain can begin with a simple thing like bending over strangely
- the nervous system can become highly sensitive, triggered by small threats
