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Integrative pain sciences > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What are the things that a patients want?

A

• To be taken seriously
• An understandable explanation of what is wrong
• Patient-centered communication (seeking patients’ perspectives/
preferences
• Reassurance and a favorable prognosis
• To be told what can be done (self and provider)

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2
Q

What are the things that a clinician want?

A
  • Focus on function
  • Program adherence
  • Increased activity level/return to work
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3
Q

What are the things that lead to improved health outcomes?

A 
Affective Bond
\+
Agreement on
• Goals
• Interventions
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4
Q

What are the characteristics of establishing the framework of patient treatment?

A

Tell the patient what to expect:

  • History
  • Examination
  • Discussion of the diagnosis/prognosis
  • Joint decision about the course of therapy
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5
Q

What are the components of the language of patient-centered care?

A 
• Begin with compassion/caring 
• Actively Listen
  - Restatement
  - Reflection
• Sample reflective “leads”
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6
Q

What are the things not to say/do with a patient?

A
  • Don’t discount the patient’s expressed beliefs
  • Don’t directly criticize a patient’ actions/decisions.
  • Don’t become defensive.
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7
Q

What are the characteristics of moving patients from pain toward function?

A 
Establishing Collaborative Goals
  - patient priorities
Setting appropriate expectations
  - Prognosis
  - PT vs pt roles
Selecting treatment approach(es)
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8
Q

What are the psychosocial

concerns a patient can present with?

A
  • Catastrophizing
  • Fear Avoidance
  • Depression
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9
Q

What are the characteristics of making referrals?

A 
Structured communication: SBAR format
• Situation
• Background
• Assessment
• Recommendation
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10
Q

What happens next after a patient referral?

A 
Medication and/or “talk therapy”
• Cognitive Behavioral Therapy
  - Automatic thoughts/emotions
  - Impact on function
• Motivational Interviewing
  - Barriers to function
  - Patient-driven
• Traditional psychotherapy
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11
Q

What are the components of patient active intervention?

A
  • Graded Exposure

- Graded Activity

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12
Q

What is graded exposure?

A

Gradual resumption of feared activities

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13
Q

What is graded activity?

A

Quota-based restoration of function regardless of symptoms

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14
Q

What are the characteristics of pain as a biomarker?

A

Lack or limited correlation between:
• Inflammatory markers and neuropathic pain
• Cystatin C levels in cerebrospinal fluid for postherpetic neuralgia
• Cystatin C levels in women experiencing labor
• Cardiac markers and chest pain associated with myocardial infarction

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15
Q

What are some of the clinical measures of pain?

A
  • Visual Analogue Scale
  • Numeric Pain Rating Scale
  • Body Diagram
  • Brief Pain Inventory
  • McGill Pain Questionnaire
  • Pain Pressure Threshold
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16
Q

What are some words used to describe patients with heightened pain behavior?

A
  • Malingering
  • Maladaptive behavior
  • Symptom magnification
  • Secondary gain
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17
Q

What are the characteristics of the Visual Analogue Scale (VAS)?

A

• Single or Multiple Item Scale
Current, Best, Worst, etc.
• Recall period, varies

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18
Q

What are the characteristics of the Numeric Pain Rating Scale (NPRS)?

A

• 0 is no pain and 10 is worst possible pain
• Most commonly an 11 point Likert scale
• Can be administered verbally and by telephone
• Acceptability:
Chronic pain patients prefer the NPRS over other measures of pain intensity due to comprehensibility and ease of completion
- Groups of chronic low back pain and symptomatic hip and knee OA have found the NPRS as inadequate

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19
Q

What is the reliability, validity, and Ability to Detect Change of the Visual Analogue Scale (VAS)?

A

Reliability

ICC= 0.97 (95% CI= 0.96-0.98)
R=0.94 for literate patients, r=0.71 for illiterate patients

Validity

Criterion validity cannot be established
High correlation with disease specific measures of disability
Validated as ratio scale: 4 cm to 2 cm can be interpreted as a 50% reduction

Ability to Detect Change

Minimum Clinically Important Difference (MCID)

  1. 1 cm in patients with rheumatoid arthritis
  2. 37 cm in patients with rotator cuff disease
  3. 0 cm for adequate pain control in emergency department
20
Q

What is the reliability, validity, and Ability to Detect Change of the Numeric Pain Rating Scale (NPRS)?

A

Reliability

R=0.96 in patients with rheumatoid arthritis
Validity

Highly correlated with VAS (0.86-0.95)

Ability to Detect Change (MCID)

2 points in low back pain
3 points or 27% reduction
2.17 points in post-operative and non-operative shoulders

21
Q

What are pain drawings used for?

A
  • Psychological evaluations
  • Documentation of symptom location
  • Diagnosis of lumbar disc disease
  • Changes in pain
  • Prediction of treatment outcome
22
Q

What are the methods of interpretation of pain drawings?

A
  • Documentation of body regions

* Grid methods

23
Q

What are the characteristics of the McGill Pain Questionnaire (MPQ)?

A

Quantitative profile of pain:
• Sensory-discriminative
• Motivational-affective
• Cognitive-evaluative

24
Q

What are the components of the McGill Pain Questionnaire (MPQ)?

A
  • Diagnosis
  • Medication
  • Pain history
  • Present pain pattern
  • Accompanying symptoms
  • Modifying factors: agg and eas
  • Effects of Pain
  • List of words
25
Q

What are the characteristics of the McGill Pain Questionnaire (MPQ) word list?

A

102 Words
• Words concerned with sensory components of pain (thermal, temporal)
• Affective qualities (fear, tension)
• Intensity and total experienced

26
Q

What are the characteristics of the application of the McGill Pain Questionnaire?

A

15-20 minutes needed when administered verbally

27
Q

What are the scoring methods of the McGill Pain Questionnaire (MPQ)?

A
  • Pain Rating Intensity Scale
  • Number of Words Chosen
  • Present Pain Intensity
28
Q

What are the characteristics of the McGill Pain Questionnaire (MPQ) - Short Form?

A 
• 15 words
• Each word or phrase rated on 4 point intensity scale
  - None= zero
  - Mild=one
  - Moderate=two
  - Severe= three
29
Q

What is the reliability, validity, and Ability to Detect Change of the McGill Pain Questionnaire (MPQ) - Short Form?

A 
• Reliability:
Correlated with long from
Test-retest (ICC=0.73-0.89) 
• Validity
Content validity established with SF36
Found to be sensitive to change
30
Q

What does the brief pain inventory include?

A 
Quadruple NPRS: best, worst, current and average
• Relief with Medication
• Pain interference
• Pain language
• Duration of pain
• Open ended descriptions
• Somatization
31
Q

What does pain interfere with as is included in the brief pain inventory?

A
  • General activity
  • Mood
  • Walking
  • Work
  • Relations with other
  • Sleep
  • Enjoyment of life
32
Q

What is the Brief Pain Inventory- Short Form ideal for?

A

Clinical practice

33
Q

What are the characteristics of the Pressure Pain Threshold (PPT)?

A
  • Algometer or Dolorimeter
  • Normally average of three
  • Pressure applied at slowly increasing rates
  • Lower PPT inversely correlated with higher pain
  • Can be utilized locally or distally
34
Q

What are the characteristics of Quantitative Sensory Testing?

A 
• Multidimensional testing paradigm including:
Pressure Pain Threshold*
Mechanical Detection Threshold
Thermal Pain Thresholds
Vibration Perception Threshold
2 Point discrimination
35
Q

What makes us happy?

A

Gratefulness

36
Q

How can we live gratefully?

A

By experiencing/ becoming aware that every moment is a given moment, a gift

37
Q

What is the gift within the gift of experiencing/becoming aware that every moment is a given moment and the gift within every gift?

A

The opportunity

38
Q

We can be grateful in ____

A

We can be grateful in every given moment

39
Q

How can we find a method for living gratefully?

A

Stop, look, and go

40
Q

What is a grateful world?

A

A world of joyful people. Grateful people are joyful people, and vice versa

41
Q

Does education only change behavior?

A

NO! We educate with movement

42
Q

How do we help patients taper opioid addiction?

A
  • Broach the subject
  • Risk benefit calculator
  • Addiction happens
  • Validation and velocity
  • Other treatments for pain
43
Q

____ is the biggest painkiller on the planet

A

Movement is the biggest painkiller on the planet

44
Q

What are major components to PNE?

A
  • Pain education
  • Aerobic exercise
  • Sleep hygiene
  • Goal setting
45
Q

What kind of input is manual therapy?

A

Bottom up input

46
Q

What is smudging?

A

Brain reorganization in chronic pain conditions where the size, resolution, and location of the cortical maps are altered.

47
Q

What are the top 10 clinical pearls for PNE?

A
  1. You have to be smarter than your patient
  2. Education should be paced,
    just like any activity
  3. All you can do…is plant the seeds
  4. Don’t force it…there’s usually a backdoor as well
  5. Tethering
  6. Boundaries
    – Being on time
    – Missing appointments
    – Not doing homework
  7. Your patients are smarter than you think
  8. All pain is real
  9. Written homework
  10. Movement is the biggest
    pain killer on the planet

Integrative pain sciences (4 decks)

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