Unit 3 Week 9 Pain Flashcards
what is the biopsychosocial perspective of pain?
pain is not a factor of just one part of a person, it is a component of interplay between sensory information, emotion and context
what is the mature organism model?
behavior is adapted for survival
sample the environment, scrutinize the input and then respond
pain perception = sensory; altered thoughts = cognitive; altered feelings = affective - all alter behavior and physiology
what is the fear-avoiding model?
perception of threat effects personal affect
high threat = priority to pain control = negative affect
low threat = priority to valued life goals = positive affect
what is pain catastrophizing?
the tendency to explain pain experience in more exaggerated terms than the average person
increases pain through altered attention, anticipation, and emotional response
what is the pain catastrophizing scale?
rumination - attention
magnification - exaggeration
helplessness - low self efficacy
what is occurring with chronic stress?
cortisol inhibits the hypothalamus and pituitary; over time the overused gland becomes less effective
lower cortisol levels impair the ability to control inflammation (immunosuppression); reduced growth factors in brain; and decreased function and size of the hippocampus (memory and mood)
what are the three cortical changes in response to pain?
size: body representation grows
laterality recognition: difficulty differentiating left from right
smudge: representation blurs
what is the cartesian model of pain?
a bottom up view of pain
pain is a direct result of tissue damage and the brain is a passive recipient of the pain signal
what is the specificity theory?
specific pain nerves, pathways, and brain center for pain
what is the pattern theory?
generic nerves respond to pain sensation with uniquely coded impulse
the frequency and intensity of the nerve signal is what creates the sensation of pain
what is the neuromatrix theory of pain?
the brain and spinal cord are what produce pain, not tissue damage
various parts of the central nervous system work together to produce pain
genetically determined and environmentally shaped
nociception + threat = pain
true/false: pain presentation is the same in both the acute and chronic phases.
true
what is nociceptive pain?
due to activation of nociceptors (inflammation, mechanical irritant, injury)
attributable to pathophysiology
how does nociceptive pain present?
localized and appropriate to injury
responds to aggravating and alleviating
intermittent and sharp with movement/provocation
constant due ache to throb at rest
what is nociplastic pain?
due to disturbance in central pain processing (increased excitability and decreased inhibition)
amplification of neural signaling in the CNS that elicits pain hypersensitivity
what is a nervous system “wind up”?
inhibition of descending inhibitory pain pathways which then skews excitatory and inhibitory inputs that contribute to the intensity of pain
changes pain thresholds and contributes to radiating of pain
what is neuropathic pain?
due to lesion or disease of the somatosensory system
how does neuropathic pain present?
referred in dermatomal or cutaneous distribution
history of nerve injury or disease
provocation with tests that load neural tissue
what is central sensitization?
disproportionate or diffused pain
what is allodynia?
painful response to a normally non-painful stimuli
what is hyperalgesia?
the amplification of the sensation of pain
what is assessed in a biopsychosocial assessment?
type of pain
somatic factors
cognitive factors
emotional factors
behavioral factors
social factors
motivation
how would you assess the quantity of pain?
visual analog scale
numeric pain rating scale
how would you assess the quality of pain?
patient characteristics
location
frequency/duration
time of day
activity and rest response
what psychosocial issues are related to central sensitization?
fear avoiding behaviors
pain catastrophizing
depression
what is 2-point discrimination?
the measure of sensory thresholds of receptive field
there will be a diminished ability in persistent pain states due to cortical changes
what is graphesthesia?
the ability to recognize a common symbol as it is drawn on the skin
what is sensation localization>
the ability to identify where the body is being touched
what should you promote when communicating your findings of a pain assessment?
safety
what should you avoid when communicating your findings of a pain assessment?
fear inducing words
(pathoanatomy)
what are the characteristics of fibromyalgia?
chronic widespread pain
fatigue and sleep alternations
cognitive dysfunction
hypersensitivity to external stimuli
somatic symptoms
psychiatric disorders
what is it hard to diagnose fibromyalgia?
lack of biomarkers
what is the hypothesized etiology of fibromyalgia?
interplay of peripheral and central mechanisms causing changes in nociceptive functions
nociplastic pain condition
what is the pathogenesis of fibromyalgia?
genetics
negative/stressful life events
peripheral injury/disease
what are the 4 pillars of fibromyalgia treatment?
patient education
fitness
pharmacology
psychotherapy
what are the parameters of exercise for patients with fibromyalgia?
short sessions initially (3-5 min)
use RPE scale to measure tolerance
increase duration in small increments (sec-min)
“no pain, no gain” does not apply
goal: 30 min/day
what mode of exercise should be used with patients with fibromyalgia?
low-moderate aerobic exercise, flexibility exercises, and strength training
aquatic therapy
