week 6 Flashcards
Which of the following are considered short-term interventions for pain? Select all that are correct.
A) Medications
B) Pain Science Education
C) Dry needling
D) Manual Therapy
ACD
Manual therapy
Manual therapy can be defined as the provision of mobilization / manipulation techniques to address musculoskeletal pain and dysfunction
Is spinal manipulative therapy effective for low back pain?
No - although statistically signficant, the findings were not clinically relevant.
what could be anti-nociceptive in providing AP GHJ glide
broad, gentle contact (think A-beta activation that might help close the gate).
Define Placebo
A therapy which is used for its non-specific psycho-physiological or presumed effect, but is without actual effect on the condition being treated. An inert substance.
What is meant by “therapeutic benefit”?
The specific or characteristic pharmacological or physiological effects of an active compound or intervention
Hawthorn effect
This is when individuals modify their behavior in response to their awareness of being observed.
Natural history
people think its plavebo
Natural healing without treatment, body heals itself
Regression to the mean
Particularly chronic diseases will go in phases and the symptoms will fluctuate.
Patients will often present at the worst stage of a cycle- it is possible then they will get better regardless of what you do
Need to be certain that your treatment is more effective than the natural history of a condition and regression to the mean
how do placebos work?
In the case of pain, placebo reduces pain output by altering nociceptive input:
A. Endogenous Opioids
Internally produced opioids that decrease nociception and reduce pain. We know this because when Naloxone (an opioid receptor antagonist) is introduced to the system the effect of the placebo is reduced
B. Non-opioid mechanisms: we don’t really understand these
What is the nocebo effect, compared to the placebo effect?
“Evil twin of placebo effect”
* Symbols, words, rituals - can provide benefit
* “Anticipation of negative effects will change the body’s perceptions and sensations”
* Expectations about negative effects
Where can the Nocebo effect be lurking?
“Every aspect of medical life and beyond”.
Are only hypochondriacs susceptible to placebo effects?
No
What is the descending pain modulation system?
Brain stem
* Nocebo uses different pathways, disables benefit from descending modulation and activates anxiety related parts of the brain
* “Turns up the volume of pain”
What parts of the nervous system is nocebo associated with?
CCK
* Prefrontal Lobes and CCK - facilitator effect on
* Different mechanisms of placebo and nocebo effect across different situations
Are the mechanisms of placebo and nocebo just the opposite of each other?
No, it’s more complex. Placebo mimics the effect of a drug
What is authorised deception and why is it important in placebo/ nocebo?
Authorised deception is getting permission to not tell patients the whole truth
* Challenging, as cornerstone of medicine is informed consent, but if we tell patients all the potential side effects then they are more likely to experience them
What is validation and what is invalidation? Why do you think these are important?
Validation: With someone and your behaviour allow them to believe that you accept
* Invalidation: “I cant find anything wrong with you”- patient feels that the doctor things they are a fraud”, but the doctor was trying to be reassuring.
* We need to reassure while still validating the patients concerns.
* Discussion of the idea of the healing response
Polysomnography ?
is a comprehensive test used to diagnose sleep disorders. Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study.
Actigraphy?
is a non-invasive method of monitoring human rest/activity cycles. The unit is usually in a wristwatch-like package worn on the wrist.
Other than polysomnography and actigraphy, clinicians can use self-reported questionnaires to assess sleep. Find a questionnaire you could use to assess a patient’s sleep.
Pittsburgh Sleep Quality Index (PSQI)
Pain and Sleep Questionnaire-3 (PSQ-3)
Verran Snyder-Halpern (VSH) sleep scale
The BPI has a sleep item
