Unit 1: Pain Theory, Perception, and Physical Agent Modalities

Question 1

Pain

Answer 1

Described as an unpleasant and emotional experience association with actual or potential tissue damage

Question 2

OT and Pain

Answer 2

Address pain which:
-Limits patients ability to participate in occupational roles
-Limits function
-Limits ROM/Strength
-Affects patients: Physically, Emotionally, and Mentally

Question 3

Managing pain enhances:

Answer 3

-Healing of soft tissue
-Movement of Body Structures
-Functional Tasks
-Participation in: home, work, hobbies, sports, school, daily activities

Question 4

Pain Symptoms

Answer 4

-Most common reason for seeking medical attention
Symptoms may contribute to:
-Structural deficits
-Protective guarding
-Anxiety/decreased sleep
-Edema
-Joint stiffness
-Tissue shortening
-Poor positioning
-Compensatory movements

Question 5

Pain Affects

Answer 5

May provoke fear, anger, withdrawal, or
anguish

Question 6

Pain symptoms are generally related to:

Answer 6

-Trauma
-Injured tissue
-Inflammation
-Muscular/neurological conditions
-Degenerative disease
-Pathological conditions

Question 7

Why pain?

Answer 7

Pain serves as a protective, warning device designed to protect the body from injury

Question 8

PAMS control pain in various ways including:

Answer 8

◦ Inhibiting inflammatory response
◦ Altering nerve conduction
◦ Increasing endorphin levels
◦ Inhibiting pain transmission at spinal cord

Question 9

PAMS Advantages

Answer 9

-Fewer and less severe side effects than pharmacological agents
-Do not cause sedation and can allow individuals to work and drive.
-PAMs can be used in conjunction with patient home exercise programs

Question 10

OT Goals (Pain)

Answer 10

-Diminish/resolve pain symptoms
-Understand pathology causing pain .
-Modify the patient’s perception of discomfort
-Maximize function within the patient’s limitations

Question 11

Types of Pain

Answer 11

-Acute: Immediate and last 24-48 hrs
-Chronic: Lasts longer than 3-6 months
-Referred: Can be stemming from another part of body where true injury has taken place

Question 12

Acute Pain

Answer 12

-Generally less than 6 months duration
-Underlying pathology can be identified
-Lasts as long as the noxious stimuli persists
-Associated with tissue damage
-Affects daily function
Occurs with sudden onset

Question 13

Acute Pain Treatment

Answer 13

Physical Agent Modalities (heat or cooling) are the most effective when treating patients in the acute stage of pain

Question 14

Treatment Goals for Acute Pain

Answer 14

-Reduce inflammation
-Facilitate resolution of pain
-Modify transmission of pain from peripheral system to central nervous system
-Educate patient regarding pain management
-Restore function

Question 15

Chronic Pain

Answer 15

-Pain that persists beyond the normal time for tissue healing
-Starts as acute pain
-Pain lasting longer than 3-6 months
-Result of activation of dysfunctional,
neurological or psychological responses

Question 16

Chronic pain may contribute to…

Answer 16

-Increased dependence on other
-Changes in meaningful relationships
-Decreased function
-Limitations with daily activities/roles
-Decreasing the risk of chronic pain with early identification of and prevention strategies may reduce the need for prolonged treatment

Question 17

Referred Pain

Answer 17

-Experiencing pain in one region when the actual tissue damage is in another region
Pain may be referred from………..
-One joint to another
-Peripheral nerve to distal innervation
-Internal organ to musculoskeletal tissue
-Trigger points

Question 18

Structures involved in Pain

Answer 18

-Peripheral Nociceptors
-Peripheral Nerve
-Central Nervous System
-Cortex/Consciousness
-Neuropathic pain

Question 19

Nociceptors

Answer 19

Sensory receptors specific to pain are located:
- Skin: sharp, pricking, tingling, Localized
- Viscera (internal organs): Aching
- Musculoskeletal Skeletal: Heavy/achy
Responsive and Sensitive
-Thermal changes
-Mechanical distortion
-Chemical components

Question 20

Peripheral Nerve FIbers (pain pathways)

Answer 20

-Specific peripheral nerves (C, A delta fibers) transmit to the spinal cord (T cells) then to
specific tracts to the brain to interpret pain.
-Specific nerve endings (nociceptors), respond to painful stimuli.

Question 21

Peripheral Nerve Pathways

Answer 21

Nociceptors: Pain Transmitting Afferent Nerve Fibers
- C fibers: Small unmyelinated fibers (80%) - slow, chronic pain
- A delta fibers: Small myelinated fibers (20 - fast, acute pain
-Transmit the sensation of pain to the spinal cord within specific tracts to the brain

Question 22

Gate Control Theory (Pain Modulation)

Answer 22

(Melzack and Wall (1965))
-PAM interventions partially control pain
by activating non-nociceptive sensory nerves.
-Inhibiting the activation of transmitting pain cells closes the gate to pain.

Question 23

Pain Assessments

Answer 23

-Visual Analog
-Numeric Scale
-FACES Assessment for Children
-Body Diagrams

Question 24

Response to Pain

Answer 24

-Behavior to the response of pain is an adapted behavior that involves learning and memory
-Individuals respond differently to pain
-Perception of pain is subjective
-Subjective pain maybe difficult to evaluate and treat

Question 25

Pain Aspects

Answer 25

-Physiologic: Tissue damage is source of pain
-Affective: Individual emotions related to pain, psychological state in response to pain
-Cognitive: How the patient reports the pain
and knowledge about the cause of their
pain
-Behavioral: Expression of pain
-Perceptual: Sensations are conveyed to the brain to alert patient of pain

Question 26

Treatment of Pain

Answer 26

-OT’s treating patients with pain have an understanding of the primary characteristics and interventions that can affect all facets of functional performance in life roles and tasks.
-Integrating PAMS and various treatment modalities allows for improved outcomes and quality of life.