Week 1: Thu 1.14.16 General Subjective Exam Flashcards
What does NLDOCAT stand for?
Nature of the problem
Location
Duration
Onset
Course- Constant & intermittent
Agg/ ease
Treatments
What is validity?
- The ability of a test or measure to to capture the phenomenon it is designed to capture. (Pg 290- Guide to evidence based PT practice)
- The extent to which the self-report instrument accurately qualifies what it intended to measure. (Setts & Carpenter pg 69)
What is Reliability?
- The extent to which repeated measures agree with one another. Also referred to as Stability, Consistency, Reproducibility. (Pg 290- Guide to evidence based PT practice)
- The consistency with which a self-report instrument measures the variable of interest such as pain, health status, ROM, function, or work status. (Setts & Carpenter Pg 69)
What is responsiveness?
The ability of a measure to detect change in the phenomenon of interest.
What is MDC?
Minimal Detectable Change
- The amount of change that just exceeds the standard error of measurement of an instrument (Pg 125- Guide to evidence based PT practice)
- The amount of change necessary to exceed measurement error (Setts & Carpenter pg 69)
What is MCID?
Minimal Clinically Important Difference
- The smallest treatment effect that would result in a change in patient management, given its side effects, costs, and inconveniences. (Pg 252- Guide to evidence based PT practice)
- Clinically meaningful level of change- the smallest meaningful change score that the patient perceives as beneficial. (Setts & Carpenter pg 69)
What is the Neuromatrix Theory of Pain?
- Proposes that pain is produced by output of a widely distributed neural network in the brain rather than purely by sensory input evoked by trauma, inflammation, or other pathology.
- Neuromatrix is a combo of cortical mechanisms that produce pain when activated, but it requires no actual sensory input (i.e noxious stimulus) to produce pain experiences.
How is pain produced by the brain according to the neuromatrix theory of pain
- Pain is produced by the brain when it perceives that body tissue is in danger and that action is required.
- Pain is a multifaceted, subjective, emotional experience produced by a characteristic neurosignature of widely distributed brain neural network called the body-self neuromatrix
3 types of input the brain integrates which affect the perception of pain
- Cognitive
- Sensory
- Motivational
Components of cognitive input which affect the perception of pain (3ish)
evaluative
- past experiences
- context
- beliefs
Components of motivational input which affect the perception of pain (3ish)
affective
- emotions
- stress
- immune system
Components of sensory input which affect the perception of pain (2ish)
discriminative
- cutaneous
- visual
3 different types of pain behavior
- somatic
- chemical
- mechanical
What is somatic pain?
- Pain caused by injury to muscles, bone, joint, and connective tissues (per google & modfied per Mincer notes
Descriptive(ish) terms for somatic pain behavior (7)
- achy, vague, poorly localized
- covering a large area
- mechanical pattern of agg/ease
- mild or severe
- pain explanding distally as it worsens
- pain without other sensory components
- deep
What is visceral pain?
- Pain that results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera (organs).
- Visceral structures are highly sensitive to distension (stretch), ischemia and inflammation, but relatively insensitive to other stimuli that normally evoke pain such as cutting or burning. (wikipedia)
Descriptive(ish) terms for visceral pain behavior? (10)
- achy, vague, poorly localized
- associated with certain days of the month
- lancinating
- associated with large meals
- not associated with movement or position
- mild or severe
- pain expands distally as it worsens
- pain without other sensory components
- referred pain can be superficial
- deep
What is radicular pain?
- A type of pain that radiates into the lower extremity directly along the course of a spinal nerve root.
- Radicular pain is caused by compression, inflammation and/or injury to a spinal nerve root arising from common conditions including herniated disc, foraminal stenosis and peridural fibrosis. (via google)
Descriptive(ish) terms for radicular pain behavior
- lancinating
- narrow band of superficial pain
- mechanical pattern of agg/ease
- mild or severe
- pain expands distally as problem worsens
- pain and paresthesia
- pain without other sensory complaint
Typical behavior of mechanical pain (5)
- result of compressive or tensile force on normal tissue (end range stretch)
- typically intermittent (on/off) pattern
- clear agg/ease factors
- predictable response to examination
- appropriate for PT exam and interventions
Typical behavior of chemical pain (4)
- result of chemical irritants in tissue due to inflammation or infection
- typically constant (unremitting)
- exam of source of chemical irritants guides initial course of treatment
- pain presenting without a mechanical component (some agg/ease) suggests acute disease state or serious pathology
Typical behavior of neuropathic pain (4ish)
- generally, pain that persists beyond time of normal healing (not all chronic pain is neuropathic)
- has components of peripheral and central sensitization
- specific source of n.pain may be radiculopathy
- Widespread symptoms of peripheral and central sensitization:
- hyperalgesia, allodynia, inconsistant aggravating and easing factors, S/S of ANS disruption (ie. poor appetite, depression, anxiety), and unpredictable or absent response to PT intervention
What does SINSS stand for and what does each thing mean?
- Severity of disorder- patient vs clinician perception
- Irritability of symptoms –What provokes symptoms, severity when provoked, duration after provoked
- Nature of complaint –What tissue/structures/systems are involved, precautions to take when treating, individuals character
- Stage of Pathology –Acute or Chronic or Combination
- Stability of symptoms –Better, worse, the same? Does that make sense with condition
Alternative terms for Acute and Chronic pain
Acute = nociceptive
Chronic = neuropathic
What is nociceptive pain?
pain arising from the stimulation of nerve cells (often as distinct from that arising from damage or disease in the nerves themselves)
What is neuropathic pain?
pain that results from direct stimulation of the myelin or nervous tissue of the peripheral or central nervous system (except for sensitized C fibers), generally felt as burning or tingling and often occurring in an area of sensory loss. It is seen commonly in patients with uncontrolled diabetes.
What is a red flag?
- Signs of serious pathology
- Examples: Cauda equina syndrome, fracture, tumor
- Some S/S: unremitting night pain, sudden weight loss of 10 pounds over 3 months, bladder & bowel incontinence, previous history of cancer, saddle anaesthesia
***pg 52 also says
- 10% loss of weight during a 4-week period unrelated to intential diet is sugestive oa neoplasm
- 5%-10% unexplained weight loss or gain over 6-12 month period is a warning sign of underlying disease.
What is an orange flag?
- Psychiatric symptoms
- Examples: Clinical depression, personality disorders
What is a yellow flag? Identify 3 categories and examples.
- caution – slow down and think about possible further screening/referral.
1. Beliefs, appraisals and judgements: Unhelpful beliefs about pain- indication of injury as uncontrollable or likely to worsen. Expectations of poor treatment outcome, delayed return to work.
2. Emotional Responses: Distress not meeting criteria for diagnosis of mental disorder. Worry, fears, anxiety.
3. Pain Behaviors (including pain coping strategies): avoidance of activities due to expectations of pain and possible reinjury. Over-reliance on passive treatments (hot packs, cold packs, analgesics)
What is a freak flag?
A characteristic, mannerism, or appearance of a person, either subtle or overt, which implies unique, eccentric, creative, adventurous or unconventional thinking.
What is a blue flag?
- Perceptions about the relationship between work and health
- Examples: Belief that work is too onerous and likely to cause further injury. Belief that workplace supervisor and workmates are unsupportive.
What is a black flag?
- A popular punk band 1976-1986
- Also, System or contextual obstacles
- Examples: Legislation restricting options for return to work. Conflict with insurance staff over injury claim. Overly solicitous family and health care providers. Heavy work, with little opportunity to modify duties.
General symptoms you may see with a Musculoskeletal Disorder
- Pain generally lessens at night
- Sharp or superficial ache
- Usually decreases with cessation of activity
- Usually continuous or intermittent
- Is aggravated by mechanical stress
General symptoms you may see with Non-Musculoskeletal disorders
- Disturbs sleep
- Deep aching or throbbing
- Reduced by pressure
- Constant or waves of pain and spasms
- Not aggravated by mechanical stress
