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Integrative Pain Science > Week 1 > Flashcards

Week 1 Flashcards

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1
Q

True or false
It is possible to have pain and not know about it

A

False

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2
Q

True or false
When part of your body is injured, special pain receptors convey the pain message to your brain

A

False (pain is an output from the brain)

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3
Q

True or false

A

The brain decides when you will experience pain

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4
Q

What percentage of the US population reports some form of chronic pain?

A

43%

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5
Q

What is the proposed scheme for treating patients in today’s world?

A

We must combine the brain and the body (focus on attitudes, beliefs, and emotional responses as well as structural problems)

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6
Q

Where is pain 100% produced?

A

In the brain

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7
Q

What is meant by pain is subjective?

A

Each person feels pain differently (pain can be reported differently even with same stimulus)

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8
Q

Pain definition

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

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9
Q

What role does the environment play in pain?

A

Pain may or may not be felt based on environment (pain may go away if you need to jump out of the way of a car)

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10
Q

What does the brain take into consideration before deciding if it should produce pain?

A

Past experience

Knowledge

Beliefs

Culture

Past successful behaviors

Past successful behaviors observed in others

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11
Q

Fear avoidance belief model

A

Turning left is going down the road of chronic pain

Turning right is leading to quick recovery

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12
Q

What is the key to neuroplasticity?

A

Focused repetition

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13
Q

What is known as the dark side of neuroplasticity?

A

A brain in chronic pain becomes more efficient at creating pain

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14
Q

What is shown in the brain in people with chronic pain?

A

They have mal adaptive changes

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15
Q

How does expectation influence pain?

A

Study about telling someone they are on opioids and pain being less and then telling them they are off and pain being more (they were on opioids the whole time)

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16
Q

What is proven to have better outcomes for patient when doing physical therapy?

A

Having a good therapeutic alliance

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17
Q

What is an example of nonconscious activation of pain?

A

Study where people link pictures of people with more or less pain even though the pain is the same

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18
Q

What is pains job?

A

Create alarms to protect the body

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19
Q

What is happening when someone is experiencing chronic pain?

A

Body is creating false alarms

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20
Q

Allodynia

A

Pain from something that does not usually cause pain

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21
Q

Hyperalgesia

A

Increased pain from something that is usually less painful

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22
Q

Sensitization

A

Less input is needed to produce pain

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23
Q

What is the specificity theory?

A

A specific nerve goes to a specific brain region

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24
Q

What are the weaknesses of the specificity theory?

A

Pain after nerve injury (phantom limb)

Hyperalgesia/allodynia

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25
Q

What is the pattern theory?

A

Nerves conduct info via specific and particular pattern

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26
Q

What is the weakness of the pattern theory?

A

Scientifically proven receptor differentiation ignored

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27
Q

What is the gate theory?

A

C fibers activate which deactivates the inhibitory neuron and allows for strong activation of pain

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28
Q

Why does rubbing help pain in the gate theory?

A

It causes A(B) fibers to activate the inhibitory neuron which lowers the pain stimulus

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29
Q

What are the weaknesses of the gate theory?

A

Ignores psychological/mood components

Over simplified

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30
Q

What theory is used mostly today to help patients?

A

Pain matrix

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31
Q

What does the probability of depression go to with 1 out of 2 negative responses?

A

20% to 5%

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32
Q

What does the probability of depression go to with 2 out of 2 negative responses?

A

20% to 50%

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33
Q

What is the depression assessment known as?

A

PHQ-9

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34
Q

What is the scoring on the PHQ-9?

A

0-27 (higher the number the worse depression)

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35
Q

What is the Orebro musculoskeletal pain questionnaire?

A

Used to identify work injured patients at risk of persistent msk problems

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36
Q

What is the STarT back test used for?

A

Back pain to assist how to appropriately manage it

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37
Q

What is scoring for the Orebro musculoskeletal pain questionnaire?

A

<57 (0 days off)

> 72 (28 days off and poor recovery)

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38
Q

What is scoring for the STarT back test?

A

<4 (low risk)

=4 (medium risk)

> 4 (high risk)

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39
Q

What is the cutoff score for the physical activity portion of the fear avoidance beliefs assessment?

A

> 15

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40
Q

What is the cutoff score for the work portion of the fear avoidance beliefs assessment?

A

> 29

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41
Q

What is the kinesiophobia assessment?

A

Fear of re injury

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42
Q

What is the scoring for the Tampa scale kinesiophobia?

A

11 (25th percentile)

22 (50th percentile, suspicion of psychological influence)

33 (75th percentile, + psychological influence)

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43
Q

What is scoring for the pain catastrophizing assessment?

A

11 (25th percentile)

20 (50th percentile, suspicion of psychological influence)

31 (75th percentile, + psychological influence)

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44
Q

Why does chronic pain occur?

A

Because of a ramped up nervous system constantly outputting pain

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45
Q

What is pain?

A

Multiple system output, activated by an individuals specific pain neural signature

46
Q

When is the neural signature in pain activated?

A

Whenever the brain perceives a threat

47
Q

What affect does worrying about something have on pain?

A

It can increase the pain because it causes your nervous system to send more impulses there

48
Q

What results in permanent changes in the CNS?

A

Bombardant of C fiber activity

49
Q

How does persistent firing of C fibers into the CNS cause chronic pain?

A

It causes interneurons to die which allows too much info into the CNS

50
Q

What does decreased endogenous mechanisms (brain function) lead to?

A

Increased sensitization (pain experience)

51
Q

What is the function of the premotor/motor cortex?

A

Organize and prepare movements

52
Q

What is the function of the cingulate cortex?

A

Concentration and focusing

53
Q

What is the function of the prefrontal cortex?

A

Problem solving and memory

54
Q

What is the function of the amygdala?

A

Fear, fear conditioning, and addiction

55
Q

What is the function of the sensory cortex?

A

Sensory discrimination

56
Q

What is the function of the hypothalamus/thalamus?

A

Stress response, autonomic regulation, and motivation

57
Q

What is the function of the cerebellum?

A

Movement and cognition

58
Q

What is the function of the hippocampus?

A

Memory, spacial recognition, and fear conditioning

59
Q

What is the function of the spinal cord?

A

Gating from the periphery

60
Q

What are two things that influence pain?

A

Adrenaline and cortisol

61
Q

What does cortisol do to the tissues?

A

Sore

Tired

Sensitive

Fatigued

62
Q

What does cortisol do to the immune system?

A

Increases nerve sensitivity

Persistent inflammation

Brain plasticity

63
Q

What causes you to feel less pain?

A

The more you learn about pain

64
Q

What doesn’t pain go away immediately?

A

It gradually decreases to protect you from doing the painful thing again

65
Q

What happens to the chemicals in the brain when you constantly feel pain?

A

The pain reducing chemicals leave the brain and you grow more sensitive to pain

66
Q

What is treatment for central sensitization?

A

Pain neuroscience education

Stress management

Graded exposure and exercise therapy (desensitization by retraining pain memories)

67
Q

How does stress lead to pain?

A

Stress leads to cortisol and adrenaline release to the brain which leads to excitatory synapses in hippocampus, amygdala, and prefrontal cortex

68
Q

Pain contingent

A

Stop doing activity when pain gets worse

69
Q

Time contingent

A

Doing an activity for a set time no matter what even if it gets painful

70
Q

How should exercise therapy work for central sensitization?

A

Use time contingent

Careful with isometric and eccentric exercise

71
Q

How can you desensitize someone using graded exposure?

A

Have them visualize painful movement

Have them watch painful movement

Have them perform painful movement

72
Q

Nociceptive pain

A

Pain that arises from actual or threatened damage to non neural tissue and is due to activation of nociceptors

73
Q

Peripheral neuropathic pain

A

Pain caused by a lesion or disease of the peripheral somatosensory nervous system

74
Q

Central sensitization

A

Increased responsiveness of nociceptive neurons in the CNS to their normal afferent input

75
Q

What word is used interchangeably with central sensitization?

A

Nociplastic pain

76
Q

What are some ways to tell if someone has nociceptive pain?

A

Localized pain

Clear mechanical or anatomical nature

Sharp with movement with constant dull ache

77
Q

How can you tell if someone has peripheral neuropathic pain?

A

Radiating pain in a dermatomal manner

History of nerve injury

78
Q

How can you tell if someone has central sensitization pain?

A

Disproportionate, non mechanical, unpredictable pattern of pain

Pain persisting beyond tissue healing time

Widespread distribution of pain

History of failed interventions

79
Q

What are the nociceptors in 1st order afferents?

A

A delta and C fibers (high threshold thermal, mechanical, and chemical)

80
Q

What are the 2nd order afferents?

A

Wide dynamic range (intensity)

Nociceptive specific (localization and type)

81
Q

Where do 2nd order afferents synapse at?

A

Dorsal horn and project to supraspinal regions via spinothalamic tract

82
Q

Where do interneurons act at?

A

Pre and post synapse at dorsal horn

83
Q

What do interneurons augment excitation of?

A

1st and 2nd order afferents

84
Q

What is the dorsal horn in charge of?

A

Sorting of info

Volume control of info

85
Q

What is ascending pain modulation?

A

Activation inhibitory interneurons that act pre and post synaptically at the dorsal horn (triggered by A-beta input) (gate control theory)

86
Q

What is descending modulation?

A

Cortical, midbrain, and brainstem structures act on dorsal horn (periaqueductal grey/medulla pathway)

87
Q

What effect does ascending pain modulation have on pain?

A

Short term pain relief

88
Q

What effect does descending modulation have on pain?

A

Constant inhibition (long term pain relief)

89
Q

What do 1st order afferents do to ion channels?

A

Increases their concentration and changes ion channel type

90
Q

What results from death of inhibitory neurons?

A

Decreased gating from the periphery

91
Q

What results when C fibers pull back and A fibers grow in?

A

Allodynia

92
Q

What results from upregulation of second order neurons?

A

Increased firing towards the brain

93
Q

What results from inappropriate synapsing other levels?

A

Spreading pain

94
Q

What results from inappropriate synapsing other fibers?

A

Sympathetic, immune, motor contributions

95
Q

What results from inappropriate synapsing other side?

A

Bilateral mirror pains

96
Q

What results from decreased endogenous mechanisms?

A

Allodynia and hyperalgesia

97
Q

Cartesian model

A

Pain can be caused by physical and psychological harm but they have no impact on eachother

98
Q

What is neuromatrix theory of pain?

A

What is used today (pain is output from the brain)

99
Q

Biomedical model of pain

A

Pain is a direct result of tissue damage

100
Q

Biopsychosocial model of pain

A

Pain is a personal experience impacted by an individuals beliefs

101
Q

What are patient contextual factors?

A

Expectation and preference

102
Q

What was the open hidden paradigm study?

A

Known machine giving drugs vs hidden machine giving drugs

103
Q

What are therapist contextual factors?

A

Clinical equipoise

104
Q

What is clinical equipoise?

A

Lack of preference or uncertainty for a treatment

105
Q

What is the combined contextual factor?

A

Therapeutic alliance

106
Q

What format is used to make referrals?

A

(SBAR)
Situation

Background

Assessment

Recommendation

107
Q

What are the clinical measures of pain?

A

Visual analogue scale

Numeric pain rating scale

Body diagram

Brief pain inventory

McGill pain questionnaire

Pain pressure threshold

108
Q

Visual analogue scale

A

Rating pain on a ruler (2cm can show reduction in pain)

109
Q

What is the importance of the McGill questionnaire?

A

102 words (narrows down which type of pain you are feeling)

110
Q

McGill questionnaire short form

A

15 words (rank them from 0-3)

111
Q

Brief pain inventory

A

Pain interference with general activity, mood, work, sleep

112
Q

What are some treatments for smudging?

A

2 point discrimination (grid)

Laterality (show picture)

Mirror therapy

Integrative Pain Science (1 decks)

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