UNIT 3: WK 1: ALL ABOUT PAIN Flashcards
Specificity Theory
specific pain nerves, pathways, and brain center for pain
Pattern Theory
Generic nerves respond to pain sensation with uniquely coded impulse
Affect Theory
Affective as a parallel process to or product of sensory process of pain
Neuromatrix Theory of pain
- brain and SC are what produce pain
- parts of CNS work together to produce pain
Neuromatrix view of pain formula
nociception (noxious stimulus) + threat (perception of danger) = PAIN
- twisting ankle while crossing street w/w/o car coming
Will reducing “threat” help reduce pain?
yes
- twisting ankle while crossing street w/w/o car coming
what dimension are altered thoughts in? What about altered feelings?
thoughts= cognitive
feelings = affective
if a person feels pain and perceives it as a low threat, what will they prioritize?
give priority to life goals
- not afraid of it
- approach pain, then recover
if a person feels pain and perceives it as a high threat, what will they prioritize?
they give priority to the pain and outward behavior will be fear and avoidance of pain & will interfere with their healing
- becomes a pain cycle
Unconditioned response to pain
feel pain –>stop what you’re doing, pay attention to it and get out of it
- wake up and have pain turning less, acknowledge it, deal with it by getting out of position
Conditioned stimulus response to pain
head turn causes pain so we FEAR IT and AVOID turning our head that way–> interferes w recovery
when you’re responding to a conditioned stimulus, what happens to other stimuli?
other stimuli get pulled into this process, like flexing neck also hurts so you have even more avoidance and pain
Interventions for when someone is responding to conditioned stimuli?
exposure– expose them to the painful movements in a safe and controlled way
Tools to help identify when someone is in the fear avoiding state
- FABQ
- Tampa Kinesiophobia Scale
what is pain catastrophizing and what does this do to their pain?
when a pt explains their pain in a much more exagerated terms than the avg person
- increases their pain through altered attention, anticipation, and emotional scale
Pain Catastrophizing scale
Rumination: attention to it all the time
Magnification: exaggeration
Helplessness: low self efficacy
Stress Response
- stimulus comes in and processed by amygdala (decides its a stress)
- hypothalamus judges how to respond based on memories (good or bad memory)
- hypothalamus sends to adrenal medulla to release epi, nor epi, and to the pituitary to stimulate adrenal cortex (to produce cortisol to maintain bp)
- immune system suppressed this whole time
Chronic Stress Effect
overused glands become less effective and body is unable to respond in actual stressful situations
body is less able to fight inflammation when cortisol levels drop
decreased size and function of hippocampus (memory & mood)
3 cortical changes that occur in response to pain
size changes: body representation in body map grows bigger
Laterality recognition: difficulty differentiating L from R
Smudge: representation blurs (person cant localize where that body part is in space)
Nociceptive Pain Dominant CAUSE, PRESENTATION
Cause: stimulation of peripheral nociceptive fibers
Presentation: pain is localized and proportionate to injury; responds to provocation and alleviation; intermittent/sharp w movement, constant dull ache to throb at rest
Peripheral Neuropathic Pain Dominant CAUSE & PRESENTATION
(injury to a nerve)
Cause: altered structure/function of peripheral nerve
presentation: pain following dermatomal or cutaneous distribution; hx of nerve injury, provocation w tests that load neural tissues
Nociplastic/Central Sensitization, CAUSE, PRESENTATION
amplification of neural signaling in the CNS that elicit pain and hypersensitivity (MAINTAINS PAIN STATE)
Cause: inhibition of descending pain pathways so the person becomes hyperactive to it
Presentation: allodynia (unwarrented pain w normal feelings); DIFFUSE PAIN; 40+ on CSI, difficult to pinpoint where pain is
SINSS for pain assessment
Severity: is it in expected proportion/distribution
Irritability: expected/alleviating factors?
Nature: symptoms match nature?
Stage: pain match stage of healing and stage of injury?
Stability: stagnant
T or F: VAS and NPRS are good for measuring a patients pain and progress with helping get rid of their pain
FALSE, not the best outcome measures.
Central Sensitization Signs
-restless leg
-stress
-headache
-digestive
-energy
-sleep
Neurotesting for pain
- 2 pt discrimination: when a pt cant discriminate two vs 1 point of contact bc of cortical changes
Graphesthesis: ability to recognize shapes, letters, numbers as theyre traced on hand
Sensation localization: can they identify where theyre being touched (Back grid)
Laterality recognition: inability to identify L vs R
Whats Fibromyalgia Syndrome? 3 most common symptoms
not well understood
Chronic widespead pain
fatigue
sleep alterations
issues w fibromyalgia
lack of biomarkers
looked at as “fake disease”
not well understood
Hypothesized etiology of fibromyalgia
interplay of peripheral and central mechanisms that are causing a nociplastic pain condition
*mind body hyperconnection where mind and body are antagonizing each other
Fibromyalgia Tx
- patient ed! Sleep, stress reduction, self efficacy (affermations, CBT)
- acknowledgement and validation
- fitness(low/mod aerobic, aquatic, walking, tai chi, pilates)
- pharmacology
- phychotherapy
*multimodal and IPE
T or F: with fibromyaglia, we want to preach “no pain, no gain” to get them stronger and better
FLASE – slow and steady pain free measured by time and not by reps
Lorimer Moseleys story about when he walked in bush with sarong on - review question
The mind is a powerful thing in a person’s interpretation of a noxious stimulus and perception of pain. Pain is both “in our heads” and very real!
A cut-score of ____ or above on the Central Sensitization Inventory has been determined to signal that a person’s pain is centralized.
40
What are two key presenting characteristics of pain in a patient who’s pain is nociplastic?
disproportionate and diffuse
*pain that has become centralized is commonly out of proportion to the tissue injury, phase of healing, or stimulus such as touch (allodynia and hyperalgesia). In addition, it is more diffuse and spreads out to areas remote to its origin.
Which of the following is true about the neuromatrix model of pain?
pain is created by processing at mutliple locations in the central nervous system
*The neuromatrix model of pain states that pain is the product of processing at various parts of the central nervous system and pain is a product of the brain and spinal cord, not tissue damage.
Which of the following patient findings reflects that “smudging” has occurred with regards to their pain?
a person has trouble localizing the borders of the painful body part
- Smudging is an adaptation to pain in which the cortical representation of the affected body part blurs.
Which is the best choice for a primary intervention in the PT treatment of fibromyalgia?
low-moderate flexibility exercises
