Unit 1: Pain Theory, Perception, and Physical Agent Modalities Flashcards
Pain
Described as an unpleasant and emotional experience association with actual or potential tissue damage
OT and Pain
Address pain which:
-Limits patients ability to participate in occupational roles
-Limits function
-Limits ROM/Strength
-Affects patients: Physically, Emotionally, and Mentally
Managing pain enhances:
-Healing of soft tissue
-Movement of Body Structures
-Functional Tasks
-Participation in: home, work, hobbies, sports, school, daily activities
Pain Symptoms
-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
Pain Affects
May provoke fear, anger, withdrawal, or
anguish
Pain symptoms are generally related to:
-Trauma
-Injured tissue
-Inflammation
-Muscular/neurological conditions
-Degenerative disease
-Pathological conditions
Why pain?
Pain serves as a protective, warning device designed to protect the body from injury
PAMS control pain in various ways including:
◦ Inhibiting inflammatory response
◦ Altering nerve conduction
◦ Increasing endorphin levels
◦ Inhibiting pain transmission at spinal cord
PAMS Advantages
-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
OT Goals (Pain)
-Diminish/resolve pain symptoms
-Understand pathology causing pain .
-Modify the patient’s perception of discomfort
-Maximize function within the patient’s limitations
Types of Pain
-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
Acute Pain
-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
Acute Pain Treatment
Physical Agent Modalities (heat or cooling) are the most effective when treating patients in the acute stage of pain
Treatment Goals for Acute Pain
-Reduce inflammation
-Facilitate resolution of pain
-Modify transmission of pain from peripheral system to central nervous system
-Educate patient regarding pain management
-Restore function
Chronic Pain
-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
Chronic pain may contribute to…
-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
Referred Pain
-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
Structures involved in Pain
-Peripheral Nociceptors
-Peripheral Nerve
-Central Nervous System
-Cortex/Consciousness
-Neuropathic pain
Nociceptors
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
Peripheral Nerve FIbers (pain pathways)
-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.
Peripheral Nerve Pathways
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
Gate Control Theory (Pain Modulation)
(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.
Pain Assessments
-Visual Analog
-Numeric Scale
-FACES Assessment for Children
-Body Diagrams
Response to Pain
-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
Pain Aspects
-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
Treatment of Pain
-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.
