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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
What does cortisol do to tissues?
Makes them: - Sore - Tired - Sensitive - Fatigued
26
What functions of the brain does cortisol affect?
- Memory - Sleep - Concentration - Blood pressure - Reproduction - Other
27
How does cortisol affect the immune system?
- Increased nerve sensitivity - Persistent inflammation - Brain plasticity
28
What are the ways to calm the nerves when a person is in pain?
- Education - Aerobic exercise - Medicine - Sleep - Relaxation, meditation, therapy
29
What should the content of the treatment of central sensitization pain include?
* Pain neuroscience education * Stress management * Graded activity & exercise therapy, including desensitization by retraining pain memories
30
Why is pain neuroscience education so important?
It leads to the reconceptualization of pain, which leads to a reduced threat value of pain, which leads to less fear
31
What is the mechanism of the HP(hypothalamus- pituitary gland) axis?
The hypothalamus and pituitary gland communicate with each other to produce cortisol, epinephrine or norepinephrine, also known as adrenaline or nor-adrenaline
32
What does stress do to the excitatory synapses in the brain?
Stress affects the cortisol & noradrenaline in the brain which then increases the excitatory synapses in hippocampus, amygdala, prefrontal cortex
33
What is the effect of stress o a molecular basis?
Central sensitization entails increased synaptic efficiency / excitatory synapses ~ learning / memory (hippocampus) ---> LTP in part regulated by cortisol & noradrenaline in the brain
34
What changes does stress have on the descending inhibition pathway?
Stress causes decreased GABA neurotransmission and decreases serotonergic activity -----> less inhibition ---> central sensitization
35
How do we treat central sensitization pain caused by pain?
Mindfulness, meditation & | Schultz relaxation ---> altered pain matrix ---> less pain
36
What is the association of physical activity and the pain matrix?
The more physical activity done, the less the pain they feel
37
What are the cognitive emotional sensitization which can be addressed by exercise therapy?
- Catastrophizing - Kinesiophobia - Somatization - Stress - Depression
38
What are some examples of a pain contingent point of view?
* “I stop gardening once the pain gets worse” | * “Please say when the exercise hurts, then we will adapt the exercise accordingly”
39
What are some examples of a time contingent point of view?
“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
What are the parameters for a time contingent exercise therapy accounting for central sensitization?
Appropriate baseline – goal setting
41
What are the other exercise therapy parameters accounting for central sensitization?
* Careful with/avoid isometric exercises * Careful with eccentric muscle contractions * Exercise & activity pacing: multiple recovery periods within and following exercise sessions
42
Why should isometric exercises be avoided for the treatment of central sensitization?
It can increase nociception or increase its rate, which will fire the pain neuromatrix
43
Why should eccentric exercises be avoided for the treatment of central sensitization?
Eccentric exercises involve local tissue damage, whose inflammation can spark or increase the sensitivity of pain receptors and nociceptors
44
What does a general treatment program for central sensitization look like?
Pain neuroscience education ---> Stress management --> Activity self management (baseline) --> Grading (activity/ exposure) ---> Recovery
45
Where is the fear center of the brain?
The amygdala
46
How do we exercise for central sensitization?
- Retraining pain memories - Retraining the memory of (movement-related) fear - Desensitization by exposure
47
Where is the memory of safety stored?
The prefrontal cortex
48
What are the parameters around retraining the memory of (movement-related) fear?
• 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
What are the take home messages of the treatment of central sensitization pain?
• 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
What is mindfulness?
Non judgemental awareness of the present moment and the breath, which can be cultivated with the process of meditation
51
What is the brain region associated with supporting meditation induced pain relief?
The orbitofrontal cortex
52
What is the role of the anterior cingulate cortex in mindfulness meditation?
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
What is the effect of deactivation of the thalamus?
It predicts meditation induced analgesia. The thalamus is critical in facilitating the transmission of pain from the body to the pain
54
What is the role of the primary somatosensory cortex?
It processes the intensity and the location of pain

Integrative pain sciences (4 decks)

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