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Integrative pain sciences > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Pain is a decision produced by the brain based on the perception of ____

A

Threat

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2
Q

What does fear avoidance lead to?

A

More pain and disability

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3
Q

What are the theories by Renee descartes in regards to pain that are wrong? What is their correct version?

A
  • Nociception and pain are synonymous: Wrong, they are 2 different things
  • Pain is an input driven system: Pain is an output by the brain
  • Nervous system is a wire: It is alot more complicated than that, it is a living, breathing organism
  • Assumption that there is a direct link between the amount of tissue damage and level of pain experienced
  • All pain is caused by injury and increased pain means more damage
  • Pain is either physical or psychological: Wrong, pain is an interwoven process
  • In chronic pain, tissues are not healing and damage is ongoing
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4
Q

What drives the nervous system?

A

Emotions, thoughts, feelings

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5
Q

What is pain?

A

A multiple system output, activated by an individual’s specific pain neural signature. The neural signature is activated whenever the brain perceives a threat

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6
Q

What is the mechanism of pain processing via body- self neuro-matrix?

A
  • Sensory
  • Cognitive
  • Affective
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7
Q

What controls your ion channels?

A

The brain

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8
Q

What are the consequences of an unhealthy peripheral nervous system?

A
  • Bombardment of C- fiber activity into the CNS dorsal horn resulting in permanent changes over time
  • Retrograde firing of nerves resulting in increased inflammation, swelling and immune responses
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9
Q

Where does sensory information come through the spinal cord?

A

The dorsal horn

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10
Q

____ is a gating mechanism for information in the spinal cord

A

Interneurons

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11
Q

What is the difference between the second order wide dynamic ranging neuron and the second order nociceptive neuron?

A

The wide dynamic neurons can fire rapidly, while the nociceptive neurons need time

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12
Q

How can more info be passed from the spinal cord up to the brain?

A

Persistent firing via C fibers over a period of time will kill the interneurons, which are the gate keepers on the dorsal horn. This is the essence of central sensitization

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13
Q

What is one of the biggest predictors of chronic pain?

A

Acute pain

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14
Q

What sensation fires easier into the dorsal horn?

A

Light touch

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15
Q

What is the consequence of the death of the inhibitory neurons in the spinal cord/dorsal horn?

A

Decreased gating from the periphery

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16
Q

What is the consequence of when C-fibers pull back; A- fibers grow in in the spinal cord/dorsal horn?

A

Allodynia: light touch hurting

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17
Q

What is the consequence of the up-regulation of second order neurons in the spinal cord/dorsal horn?

A

Increased firing towards the brain

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18
Q

What is the consequence of inappropriate synapsing- other levels in the spinal cord/dorsal horn?

A

Spreading pain

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19
Q

What is the consequence of inappropriate synapsing- other fibers in the spinal cord/dorsal horn?

A

Sympathetic, immune, motor contributions

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20
Q

What is the consequence of inappropriate synapsing- other sidein the spinal cord/dorsal horn?

A

Bilateral “mirror” pains

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21
Q

What is the consequence of decreased endogenous mechanisms in the spinal cord/dorsal horn?

A

Allodynia and Hyperalgesia: increased sensitization/pain experience

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22
Q

What are the common areas in the brain frequently ignited during pain?

A
  • Premotor/ motor cortex: organize and prepare movements
  • Cingulate cortex: concentration, focus
  • Prefrontal cortex: problem solving, memory
  • Amygdala: fear, fear conditioning, addiction
  • Sensory cortex: sensory discrimination
  • Hypothalamus/thalamus: stress response, autonomic regulation, motivation
  • Cerebellum: movement and cognition
  • Hippocampus: memory, special recognition, fear conditioning
  • Spinal cord: gating from the periphery
23
Q

What happens in the brain when a person is in a potentially dangerous situation?

A
  • How dangerous is this? –> This is dangerous/i need more info —> Facilitation/neuronal adaptation
  • How dangerous is this? —> this is not dangerous —> inhibition endogenous
24
Q

What are the body’s main distress chemicals?

A
  • Adrenaline

- Cortisol

25
Q

What does cortisol do to tissues?

A

Makes them:

  • Sore
  • Tired
  • Sensitive
  • Fatigued
26
Q

What functions of the brain does cortisol affect?

A
  • Memory
  • Sleep
  • Concentration
  • Blood pressure
  • Reproduction
  • Other
27
Q

How does cortisol affect the immune system?

A
  • Increased nerve sensitivity
  • Persistent inflammation
  • Brain plasticity
28
Q

What are the ways to calm the nerves when a person is in pain?

A
  • Education
  • Aerobic exercise
  • Medicine
  • Sleep
  • Relaxation, meditation, therapy
29
Q

What should the content of the treatment of central sensitization pain include?

A
  • Pain neuroscience education
  • Stress management
  • Graded activity & exercise therapy, including desensitization by retraining pain memories
30
Q

Why is pain neuroscience education so important?

A

It leads to the reconceptualization of pain, which leads to a reduced threat value of pain, which leads to less fear

31
Q

What is the mechanism of the HP(hypothalamus- pituitary gland) axis?

A

The hypothalamus and pituitary gland communicate with each other to produce cortisol, epinephrine or norepinephrine, also known as adrenaline or nor-adrenaline

32
Q

What does stress do to the excitatory synapses in the brain?

A

Stress affects the cortisol & noradrenaline in the brain which then increases the
excitatory synapses in hippocampus, amygdala, prefrontal cortex

33
Q

What is the effect of stress o a molecular basis?

A

Central sensitization entails increased synaptic efficiency /
excitatory synapses ~ learning / memory (hippocampus)
—> LTP in part regulated by cortisol & noradrenaline in the brain

34
Q

What changes does stress have on the descending inhibition pathway?

A

Stress causes decreased GABA neurotransmission and decreases serotonergic activity —–> less inhibition —> central sensitization

35
Q

How do we treat central sensitization pain caused by pain?

A

Mindfulness, meditation &

Schultz relaxation —> altered pain matrix —> less pain

36
Q

What is the association of physical activity and the pain matrix?

A

The more physical activity done, the less the pain they feel

37
Q

What are the cognitive emotional sensitization which can be addressed by exercise therapy?

A
  • Catastrophizing
  • Kinesiophobia
  • Somatization
  • Stress
  • Depression
38
Q

What are some examples of a pain contingent point of view?

A
  • “I stop gardening once the pain gets worse”

* “Please say when the exercise hurts, then we will adapt the exercise accordingly”

39
Q

What are some examples of a time contingent point of view?

A

“I garden for 20 minutes. That we have agreed. If after 20 minutes I feel that I can still continue, I stop anyway. If the pain worsens after 15 minutes, I continue anyway.”

40
Q

What are the parameters for a time contingent exercise therapy accounting for central sensitization?

A

Appropriate baseline – goal setting

41
Q

What are the other exercise therapy parameters accounting for central sensitization?

A
  • Careful with/avoid isometric exercises
  • Careful with eccentric muscle contractions
  • Exercise & activity pacing: multiple recovery periods within and following exercise sessions
42
Q

Why should isometric exercises be avoided for the treatment of central sensitization?

A

It can increase nociception or increase its rate, which will fire the pain neuromatrix

43
Q

Why should eccentric exercises be avoided for the treatment of central sensitization?

A

Eccentric exercises involve local tissue damage, whose inflammation can spark or increase the sensitivity of pain receptors and nociceptors

44
Q

What does a general treatment program for central sensitization look like?

A

Pain neuroscience education —> Stress management –> Activity self management
(baseline) –> Grading (activity/ exposure) —> Recovery

45
Q

Where is the fear center of the brain?

A

The amygdala

46
Q

How do we exercise for central sensitization?

A
  • Retraining pain memories
  • Retraining the memory of (movement-related) fear
  • Desensitization by exposure
47
Q

Where is the memory of safety stored?

A

The prefrontal cortex

48
Q

What are the parameters around retraining the memory of (movement-related) fear?

A

• What kind of movements will damage your back? Please indicate the threat value on a scale ranging from 0 to
10.
• Thorough questioning of perceptions about these movements: anticipated body response etc.
• Discussion of movements’ perceptions – challange the patient’s cognitions prior to executing the movement / exercise

49
Q

What are the take home messages of the treatment of central sensitization pain?

A

• Pain neuroscience education is the first (effective) step
• Long-term stress accelerates the mechanism of central
sensitization: stress management is often a cardinal part of treatment
• Graded activity & exercise therapy should account for cognitive emotional sensitization
• Exercise therapy implies desensitization by retraining pain memories

50
Q

What is mindfulness?

A

Non judgemental awareness of the present moment and the breath, which can be cultivated with the process of meditation

51
Q

What is the brain region associated with supporting meditation induced pain relief?

A

The orbitofrontal cortex

52
Q

What is the role of the anterior cingulate cortex in mindfulness meditation?

A

It predicts meditation induced analgesia. This region has been repeatedly found to control pain through retention as well as the ability to regulate emotional responses to pain

53
Q

What is the effect of deactivation of the thalamus?

A

It predicts meditation induced analgesia. The thalamus is critical in facilitating the transmission of pain from the body to the pain

54
Q

What is the role of the primary somatosensory cortex?

A

It processes the intensity and the location of pain

Integrative pain sciences (4 decks)

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