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
can we turn down the alarm system therapeutically ?
yes
•Therapeutic Neuroscience Education
•Aerobic Exercise
•Manual Therapy •Breathing, relaxation, mediation
•Modalities
- this info is very effective, changes convo from whats wrong with me to “where do we go” nervousness train of though of fixing to “calming the NS”
What happens after TNE is delivered for the patient?
after TNE that patient understands: Tissues heal; tissues sensitive; sore and deconditioned
- the lightbulb turns on and we see that the threat is smaller (we’re not making anything slip out of place) and the threat-movement- wont hurt tissues
- im not going to injure myself im just sensitive = ability to bend further
what should subsequent therapy look like?
•Session 30-45 minutes •Exercise •Pacing and graded exposure •Constant pain education – more in-depth including: -The Brain and Pain -Output mechanisms and Pain •Home Exercise Program •Goal Setting
What can TNE do?
- Changes in regards to pain beliefs
- Changes in regards to attitudes
- Improved cognition •Improved physical performance
- Increased pain thresholds •Improved outcomes from exercise
- Decreased brain activation •Improved function
- Patients able to take on complex pain issues
Can TNE be used preoperatively?
yes
study showed that at 1 year follow up
- One year follow-up (superior results):
•Back/leg Pain •Catastrophization
•Fear Avoidance
•Pain Knowledge •Satisfaction with surgery •42% healthcare savings
Why is TNE effective?
•Redefine pain and thus change cognitions regarding pain
•Pain and Tissue injury are two different things •Reduces threat
- we TREAT pain, not just manage it
why do patients get better
many resaons, we socus on the right Ex and MT bu t we need to recognize there are other reasons
- some changes happen naturally reglardless of tx
Rehab outcomes are seen by what 3 factors?
3 shoudl be overlapping
- threapist fxs
- patients faxs
and envirometn fxs
what are Patient Contextual Factors ?
- Expectation
- palcebo is as effective as TX
- a negative expectation has neg outcomes; nocebo
2.Preference
Pts want info, but few want to have role in clinical decision making. They came to a professional and unless that have strong preference on how to be Tx’s, they trust the clinician
