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Integrative pain sciences > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What is the 1st important thing in understanding pain?

A

Getting assessed and ruling out anything dangerous

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2
Q

What are the other important components of understanding pain?

A
  • Get informed and manage pain from a broad, active perspective
  • Make the mind- body link: draw a timeline for emotional impact before, during and after onset of pain
  • Identify underlying depression and anxiety early
  • Reconnect to life
  • Sleep, rest and ongoing physical activity
  • Good nutrition
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3
Q

What are the things that fall under body information?

A
  • Muscles and bones
  • Joints/tendons/ ligaments/ fascia/ skin
  • Spinal discs
  • Blood vessels
  • Organs
  • Chemistry
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4
Q

What are the environmental factors that contributes to pain?

A
  • Physical
  • Mood
  • Emotion
  • Sleep
  • Social
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5
Q

How many decision making areas are in the brain?

A

9

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6
Q

What do protection memories look at?

A
  • Previous injury
  • Previous pain
  • What do i know about this?
  • What have i done?
  • What have others done?
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7
Q

What do protection memories become when a person?

A

It becomes input/ nerve impulses

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8
Q

What happens after protection memories have becomes an input?

A

The brain processes it and creates an output: pain, movement changes (strength, endurance, stiffness, muscle coordination/balance), changes in body physiology(immune system, endocrine)

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9
Q

What is the definition of pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

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10
Q

What is allodynia?

A

Pain due to a stimulus that does not normally provoke pain.

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11
Q

What is hyperalgesia?

A

Increased pain from a stimulus that normally

provokes pain

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12
Q

What is sensitization?

A

Increased responsiveness of nociceptive neurons to their normal input, and/or recruitment of a response to normally sub-threshold inputs

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13
Q

What is central sensitization?

A

Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.

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14
Q

What is peripheral sensitization?

A

Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields.

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15
Q

According to ancient china, what was too much yin equated to?

A

Tissue damage and swelling

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16
Q

According to ancient china, what was too much yang equated to?

A

Pain

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17
Q

What are pain afferents usually described as and what are they?

A
  • Slow fibers

- A-delta and C fibers

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18
Q

What are other sensory afferents usually described as and what are they?

A
  • Fast fibers

- Usually A- beta

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19
Q

What is summation?

A

The progressive build- up of a nerve signal

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20
Q

What does the specificity theory look at?

A

A specific nerve, in a specific brain region

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21
Q

The specificity theory is supported by ____

A

Finding of nociceptors

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22
Q

What are the weaknesses of the specificity theory?

A
  • Pain After Nerve Injury, Phantom Limb

* Hyperalgesia/Allodynia

23
Q

What is the pattern theory?

A

Nerves conduct info via specific and particular pattern. No specificity of receptors

24
Q

What is the weakness of the pattern theory?

A

Scientifically proven receptor differentiation

ignored

25
Q

What is the gate theory?

A

A combination of both specificity and pattern theories.

26
Q

How does a pain stimulus work?

A

C fibers block the inhibitory interneuron, which will cause a strong activation of pain

27
Q

What effect does rubbing have on gating pain?

A

It increases the amount of A beta firing, so the transmission of the C- fiber is weak/less

28
Q

What are central control triggers?

A

Some sort of input or effect from the higher levels of the brain

29
Q

What do central control triggers do?

A 
• Neural Tract - Faster than Pain Pathways
• Send Info on Location/Extent of Injury
• Elicits Descending Efferent Activity
    - Influences Gate
• Brain Modules Coming Info
30
Q

What are the weaknesses of the gate theory?

A 
• Ignores Psychological/Mood Components
• Over-Simplified
• Premise - Neural System is Hardwired
   • Neural Plasticity - Altered
        - Thresholds
        - Neurotransmitter Density
        - Descending Control
        - Cortical Activity
31
Q

What type of practice approach should PTs take towards dealing with pain?

A

Psychologically Informed Practice

32
Q

What are black flags?

A

Healthcare system

• Legislation, insurance limitations

33
Q

What are blue flags?

A

Work-related factors

• belief that work is likely to cause injury or that supervisor is unsupportive

34
Q

What are orange flags?

A

Psychiatric symptoms

• depression, personality disorder

35
Q

What are yellow flags?

A 
Beliefs, appraisals, and judgments  
• pain catastrophizing  
Emotional responses  
• worry, fears, anxiety 
Pain behavior  
• avoidance of activity due to pain
36
Q

What are the probabilities of depression based on the results of a depression screening?

A
  • Probability of severe depression decreases from 20% to about 5% with one negative response.
  • Probability of severe depression increases from 20% to 50% with 2 positive responses
37
Q

What should be done if a patient is positive on the 2 question depression screening?

A

Consider full questionnaire option
• Assesses diagnosis and severity of depression
• Question #9 relates to suicidal ideation
- Reliable and valid tool that is sensitive to change in depression severity over time

38
Q

What does a score of 0-4 on the PHQ-9 mean?

A

No depression

39
Q

What does a score of 5-9 on the PHQ-9 mean?

A

Mild Depression

40
Q

What does a score of 10-14 on the PHQ-9 mean?

A

Moderate Depression

41
Q

What does a score of 15-19 on the PHQ-9 mean?

A

Moderately Severe Depression

42
Q

What does a score of 20-27 on the PHQ-9 mean?

A

Severe Depression

43
Q

What are the cut-off scores of the Örebro Musculoskeletal Pain Questionnaire Short Form?

A
  • 0 paid days off work – <57 (+LR 4.6)
  • 28 days or more off – >72 (+LR 3.4)
  • Poor recovery – > 72 (+LR 4.9)
  • NRS – >72 (+LR 4.9)

• Score over 72, consider assessing specific factors

44
Q

What are the score interpretations of the STarT Back screening tool?

A

• Low risk → (overall score <4)
- suitable for primary care management?
• Medium risk → (overall score ≥ 4)
- suitable for physical therapy?
• High risk → (psychosocial subscale score ≥ 4)
- require a combination of physical and cognitive-behavioral approaches?

45
Q

What is the cut off score for a FABQpa and who is it mostly used for?

A

• General practice and osteopathic patients • FABQ-PA > 15

46
Q

What is the cut off score for a FABQw and who is it mostly used for?

A
  • Acute, work related low back pain
  • FABQ-W > 29
  • No compensation, general orthopedic patients
  • FABQ-W > 22
47
Q

What are the recommended cut off scores fo the Tampa Scale of Kinesiophobia (TSK-11)?

A
  • 25th Percentile (TSK = 11)
  • 50th Percentile (TSK = 22)
  • 75th Percentile (TSK = 33)
  • Above 50th suspicion of psychological influence
  • Above 75th consider “positive” for psychological influence
48
Q

What are the cut off scores for the Pain Catastrophizing Assessment (PCS)?

A
  • 25th Percentile (PCS = 11)
  • 50th Percentile (PCS = 20)
  • 75th Percentile (PCS = 31)
  • Above 50th (more than 20 questions) suspicion of psychological influence
  • Above 75th (more than 31 questions) consider “positive” for psychological influence
49
Q

What outcome measure should be used when measuring fear across multiple anatomical locations?

A

Consider TSK or modified FABQ (changing from “back” focused)

50
Q

What are the things that affects how a person’s brain perceives an output?

A
  • Past experiences
  • Knowledge
  • Culture
  • Beliefs
  • Past successful behavior
  • Past successful behavior observed in others
51
Q

What does the motivation- valuation circuitry do?

A

Predicts pain persistence raises the possibility that, as with positive reinforcement learning, the Nucleus Accumbens contributes to an aversive teaching signal that leads to sustained pain intensity over time following a static peripheral injury.

52
Q

What were the results of “Chronic pain affects brain networks” done by Davis et al?

A

Results imply that the functional reorganization of the insula and sensorimotor cortex are coupled with gray matter changes and directly relate to the persistence of pain.

53
Q

For a patient in chronic pain the fear of exercise may be a ____

A

Reasonable, knowledgeable, and learned response to a noxious stimulus.

54
Q

What is therapeutic alliance?

A

The relationship between a healthcare professional and a client. It is the means by which a therapist and a client hope to engage with each other, and effect beneficial change in the client.

Integrative pain sciences (4 decks)

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