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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
What is the gate theory?
A combination of both specificity and pattern theories.
26
How does a pain stimulus work?
C fibers block the inhibitory interneuron, which will cause a strong activation of pain
27
What effect does rubbing have on gating pain?
It increases the amount of A beta firing, so the transmission of the C- fiber is weak/less
28
What are central control triggers?
Some sort of input or effect from the higher levels of the brain
29
What do central control triggers do?
``` • Neural Tract - Faster than Pain Pathways • Send Info on Location/Extent of Injury • Elicits Descending Efferent Activity - Influences Gate • Brain Modules Coming Info ```
30
What are the weaknesses of the gate theory?
``` • Ignores Psychological/Mood Components • Over-Simplified • Premise - Neural System is Hardwired • Neural Plasticity - Altered - Thresholds - Neurotransmitter Density - Descending Control - Cortical Activity ```
31
What type of practice approach should PTs take towards dealing with pain?
Psychologically Informed Practice
32
What are black flags?
Healthcare system | • Legislation, insurance limitations
33
What are blue flags?
Work-related factors | • belief that work is likely to cause injury or that supervisor is unsupportive
34
What are orange flags?
Psychiatric symptoms | • depression, personality disorder
35
What are yellow flags?
``` Beliefs, appraisals, and judgments • pain catastrophizing Emotional responses • worry, fears, anxiety Pain behavior • avoidance of activity due to pain ```
36
What are the probabilities of depression based on the results of a depression screening?
- 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
What should be done if a patient is positive on the 2 question depression screening?
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
What does a score of 0-4 on the PHQ-9 mean?
No depression
39
What does a score of 5-9 on the PHQ-9 mean?
Mild Depression
40
What does a score of 10-14 on the PHQ-9 mean?
Moderate Depression
41
What does a score of 15-19 on the PHQ-9 mean?
Moderately Severe Depression
42
What does a score of 20-27 on the PHQ-9 mean?
Severe Depression
43
What are the cut-off scores of the Örebro Musculoskeletal Pain Questionnaire Short Form?
* 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
What are the score interpretations of the STarT Back screening tool?
• 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
What is the cut off score for a FABQpa and who is it mostly used for?
• General practice and osteopathic patients • FABQ-PA > 15
46
What is the cut off score for a FABQw and who is it mostly used for?
* Acute, work related low back pain * FABQ-W > 29 * No compensation, general orthopedic patients * FABQ-W > 22
47
What are the recommended cut off scores fo the Tampa Scale of Kinesiophobia (TSK-11)?
* 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
What are the cut off scores for the Pain Catastrophizing Assessment (PCS)?
* 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
What outcome measure should be used when measuring fear across multiple anatomical locations?
Consider TSK or modified FABQ (changing from “back” focused)
50
What are the things that affects how a person's brain perceives an output?
- Past experiences - Knowledge - Culture - Beliefs - Past successful behavior - Past successful behavior observed in others
51
What does the motivation- valuation circuitry do?
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
What were the results of "Chronic pain affects brain networks" done by Davis et al?
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
For a patient in chronic pain the fear of exercise may be a ____
Reasonable, knowledgeable, and learned response to a noxious stimulus.
54
What is therapeutic alliance?
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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