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Integrative Pain Science > Week 1 > Flashcards

Week 1 Flashcards

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
What is the pattern theory?
Nerves conduct info via specific and particular pattern
26
What is the weakness of the pattern theory?
Scientifically proven receptor differentiation ignored
27
What is the gate theory?
C fibers activate which deactivates the inhibitory neuron and allows for strong activation of pain
28
Why does rubbing help pain in the gate theory?
It causes A(B) fibers to activate the inhibitory neuron which lowers the pain stimulus
29
What are the weaknesses of the gate theory?
Ignores psychological/mood components Over simplified
30
What theory is used mostly today to help patients?
Pain matrix
31
What does the probability of depression go to with 1 out of 2 negative responses?
20% to 5%
32
What does the probability of depression go to with 2 out of 2 negative responses?
20% to 50%
33
What is the depression assessment known as?
PHQ-9
34
What is the scoring on the PHQ-9?
0-27 (higher the number the worse depression)
35
What is the Orebro musculoskeletal pain questionnaire?
Used to identify work injured patients at risk of persistent msk problems
36
What is the STarT back test used for?
Back pain to assist how to appropriately manage it
37
What is scoring for the Orebro musculoskeletal pain questionnaire?
<57 (0 days off) > 72 (28 days off and poor recovery)
38
What is scoring for the STarT back test?
<4 (low risk) =4 (medium risk) >4 (high risk)
39
What is the cutoff score for the physical activity portion of the fear avoidance beliefs assessment?
>15
40
What is the cutoff score for the work portion of the fear avoidance beliefs assessment?
>29
41
What is the kinesiophobia assessment?
Fear of re injury
42
What is the scoring for the Tampa scale kinesiophobia?
11 (25th percentile) 22 (50th percentile, suspicion of psychological influence) 33 (75th percentile, + psychological influence)
43
What is scoring for the pain catastrophizing assessment?
11 (25th percentile) 20 (50th percentile, suspicion of psychological influence) 31 (75th percentile, + psychological influence)
44
Why does chronic pain occur?
Because of a ramped up nervous system constantly outputting pain
45
What is pain?
Multiple system output, activated by an individuals specific pain neural signature
46
When is the neural signature in pain activated?
Whenever the brain perceives a threat
47
What affect does worrying about something have on pain?
It can increase the pain because it causes your nervous system to send more impulses there
48
What results in permanent changes in the CNS?
Bombardant of C fiber activity
49
How does persistent firing of C fibers into the CNS cause chronic pain?
It causes interneurons to die which allows too much info into the CNS
50
What does decreased endogenous mechanisms (brain function) lead to?
Increased sensitization (pain experience)
51
What is the function of the premotor/motor cortex?
Organize and prepare movements
52
What is the function of the cingulate cortex?
Concentration and focusing
53
What is the function of the prefrontal cortex?
Problem solving and memory
54
What is the function of the amygdala?
Fear, fear conditioning, and addiction
55
What is the function of the sensory cortex?
Sensory discrimination
56
What is the function of the hypothalamus/thalamus?
Stress response, autonomic regulation, and motivation
57
What is the function of the cerebellum?
Movement and cognition
58
What is the function of the hippocampus?
Memory, spacial recognition, and fear conditioning
59
What is the function of the spinal cord?
Gating from the periphery
60
What are two things that influence pain?
Adrenaline and cortisol
61
What does cortisol do to the tissues?
Sore Tired Sensitive Fatigued
62
What does cortisol do to the immune system?
Increases nerve sensitivity Persistent inflammation Brain plasticity
63
What causes you to feel less pain?
The more you learn about pain
64
What doesn’t pain go away immediately?
It gradually decreases to protect you from doing the painful thing again
65
What happens to the chemicals in the brain when you constantly feel pain?
The pain reducing chemicals leave the brain and you grow more sensitive to pain
66
What is treatment for central sensitization?
Pain neuroscience education Stress management Graded exposure and exercise therapy (desensitization by retraining pain memories)
67
How does stress lead to pain?
Stress leads to cortisol and adrenaline release to the brain which leads to excitatory synapses in hippocampus, amygdala, and prefrontal cortex
68
Pain contingent
Stop doing activity when pain gets worse
69
Time contingent
Doing an activity for a set time no matter what even if it gets painful
70
How should exercise therapy work for central sensitization?
Use time contingent Careful with isometric and eccentric exercise
71
How can you desensitize someone using graded exposure?
Have them visualize painful movement Have them watch painful movement Have them perform painful movement
72
Nociceptive pain
Pain that arises from actual or threatened damage to non neural tissue and is due to activation of nociceptors
73
Peripheral neuropathic pain
Pain caused by a lesion or disease of the peripheral somatosensory nervous system
74
Central sensitization
Increased responsiveness of nociceptive neurons in the CNS to their normal afferent input
75
What word is used interchangeably with central sensitization?
Nociplastic pain
76
What are some ways to tell if someone has nociceptive pain?
Localized pain Clear mechanical or anatomical nature Sharp with movement with constant dull ache
77
How can you tell if someone has peripheral neuropathic pain?
Radiating pain in a dermatomal manner History of nerve injury
78
How can you tell if someone has central sensitization pain?
Disproportionate, non mechanical, unpredictable pattern of pain Pain persisting beyond tissue healing time Widespread distribution of pain History of failed interventions
79
What are the nociceptors in 1st order afferents?
A delta and C fibers (high threshold thermal, mechanical, and chemical)
80
What are the 2nd order afferents?
Wide dynamic range (intensity) Nociceptive specific (localization and type)
81
Where do 2nd order afferents synapse at?
Dorsal horn and project to supraspinal regions via spinothalamic tract
82
Where do interneurons act at?
Pre and post synapse at dorsal horn
83
What do interneurons augment excitation of?
1st and 2nd order afferents
84
What is the dorsal horn in charge of?
Sorting of info Volume control of info
85
What is ascending pain modulation?
Activation inhibitory interneurons that act pre and post synaptically at the dorsal horn (triggered by A-beta input) (gate control theory)
86
What is descending modulation?
Cortical, midbrain, and brainstem structures act on dorsal horn (periaqueductal grey/medulla pathway)
87
What effect does ascending pain modulation have on pain?
Short term pain relief
88
What effect does descending modulation have on pain?
Constant inhibition (long term pain relief)
89
What do 1st order afferents do to ion channels?
Increases their concentration and changes ion channel type
90
What results from death of inhibitory neurons?
Decreased gating from the periphery
91
What results when C fibers pull back and A fibers grow in?
Allodynia
92
What results from upregulation of second order neurons?
Increased firing towards the brain
93
What results from inappropriate synapsing other levels?
Spreading pain
94
What results from inappropriate synapsing other fibers?
Sympathetic, immune, motor contributions
95
What results from inappropriate synapsing other side?
Bilateral mirror pains
96
What results from decreased endogenous mechanisms?
Allodynia and hyperalgesia
97
Cartesian model
Pain can be caused by physical and psychological harm but they have no impact on eachother
98
What is neuromatrix theory of pain?
What is used today (pain is output from the brain)
99
Biomedical model of pain
Pain is a direct result of tissue damage
100
Biopsychosocial model of pain
Pain is a personal experience impacted by an individuals beliefs
101
What are patient contextual factors?
Expectation and preference
102
What was the open hidden paradigm study?
Known machine giving drugs vs hidden machine giving drugs
103
What are therapist contextual factors?
Clinical equipoise
104
What is clinical equipoise?
Lack of preference or uncertainty for a treatment
105
What is the combined contextual factor?
Therapeutic alliance
106
What format is used to make referrals?
(SBAR) Situation Background Assessment Recommendation
107
What are the clinical measures of pain?
Visual analogue scale Numeric pain rating scale Body diagram Brief pain inventory McGill pain questionnaire Pain pressure threshold
108
Visual analogue scale
Rating pain on a ruler (2cm can show reduction in pain)
109
What is the importance of the McGill questionnaire?
102 words (narrows down which type of pain you are feeling)
110
McGill questionnaire short form
15 words (rank them from 0-3)
111
Brief pain inventory
Pain interference with general activity, mood, work, sleep
112
What are some treatments for smudging?
2 point discrimination (grid) Laterality (show picture) Mirror therapy

Integrative Pain Science (1 decks)

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