UNIT 3: WK 1: ALL ABOUT PAIN

Question 1

Specificity Theory

Answer 1

specific pain nerves, pathways, and brain center for pain

Question 2

Pattern Theory

Answer 2

Generic nerves respond to pain sensation with uniquely coded impulse

Question 3

Affect Theory

Answer 3

Affective as a parallel process to or product of sensory process of pain

Question 4

Neuromatrix Theory of pain

Answer 4

1. brain and SC are what produce pain
2. parts of CNS work together to produce pain

Question 5

Neuromatrix view of pain formula

Answer 5

nociception (noxious stimulus) + threat (perception of danger) = PAIN

• twisting ankle while crossing street w/w/o car coming

Question 6

Will reducing “threat” help reduce pain?

Answer 6

yes

• twisting ankle while crossing street w/w/o car coming

Question 7

what dimension are altered thoughts in? What about altered feelings?

Answer 7

thoughts= cognitive
feelings = affective

Question 8

if a person feels pain and perceives it as a low threat, what will they prioritize?

Answer 8

give priority to life goals
- not afraid of it

• approach pain, then recover

Question 9

if a person feels pain and perceives it as a high threat, what will they prioritize?

Answer 9

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

Question 10

Unconditioned response to pain

Answer 10

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

Question 11

Conditioned stimulus response to pain

Answer 11

head turn causes pain so we FEAR IT and AVOID turning our head that way–> interferes w recovery

Question 12

when you’re responding to a conditioned stimulus, what happens to other stimuli?

Answer 12

other stimuli get pulled into this process, like flexing neck also hurts so you have even more avoidance and pain

Question 13

Interventions for when someone is responding to conditioned stimuli?

Answer 13

exposure– expose them to the painful movements in a safe and controlled way

Question 14

Tools to help identify when someone is in the fear avoiding state

Answer 14

• FABQ
• Tampa Kinesiophobia Scale

Question 15

what is pain catastrophizing and what does this do to their pain?

Answer 15

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

Question 16

Pain Catastrophizing scale

Answer 16

Rumination: attention to it all the time
Magnification: exaggeration
Helplessness: low self efficacy

Question 17

Stress Response

Answer 17

1. stimulus comes in and processed by amygdala (decides its a stress)
2. hypothalamus judges how to respond based on memories (good or bad memory)
3. 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

Question 18

Chronic Stress Effect

Answer 18

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)

Question 18

3 cortical changes that occur in response to pain

Answer 18

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)

Question 18

Nociceptive Pain Dominant CAUSE, PRESENTATION

Answer 18

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

Question 19

Peripheral Neuropathic Pain Dominant CAUSE & PRESENTATION

Answer 19

(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

Question 20

Nociplastic/Central Sensitization, CAUSE, PRESENTATION

Answer 20

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

Question 21

SINSS for pain assessment

Answer 21

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

Question 22

T or F: VAS and NPRS are good for measuring a patients pain and progress with helping get rid of their pain

Answer 22

FALSE, not the best outcome measures.

Question 23

Central Sensitization Signs

Answer 23

-restless leg
-stress
-headache
-digestive
-energy
-sleep

Question 24

Neurotesting for pain

Answer 24

• 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

Question 25

Whats Fibromyalgia Syndrome? 3 most common symptoms

Answer 25

not well understood

Chronic widespead pain
fatigue
sleep alterations

Question 26

issues w fibromyalgia

Answer 26

lack of biomarkers
looked at as “fake disease”
not well understood

Question 27

Hypothesized etiology of fibromyalgia

Answer 27

interplay of peripheral and central mechanisms that are causing a nociplastic pain condition

*mind body hyperconnection where mind and body are antagonizing each other

Question 28

Fibromyalgia Tx

Answer 28

• 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

Question 29

T or F: with fibromyaglia, we want to preach “no pain, no gain” to get them stronger and better

Answer 29

FLASE – slow and steady pain free measured by time and not by reps

Question 30

Lorimer Moseleys story about when he walked in bush with sarong on - review question

Answer 30

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!

Question 31

A cut-score of ____ or above on the Central Sensitization Inventory has been determined to signal that a person’s pain is centralized.

Answer 31

40

Question 32

What are two key presenting characteristics of pain in a patient who’s pain is nociplastic?

Answer 32

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.

Question 33

Which of the following is true about the neuromatrix model of pain?

Answer 33

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.

Question 34

Which of the following patient findings reflects that “smudging” has occurred with regards to their pain?

Answer 34

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.

Question 35

Which is the best choice for a primary intervention in the PT treatment of fibromyalgia?

Answer 35

low-moderate flexibility exercises