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S4- CP3 > Week 6- Pain Neuroscience Education (PNE) > Flashcards

Week 6- Pain Neuroscience Education (PNE) Flashcards

1
Q

PART 1: CLINICAL ASSESSMENT OF CHRONIC PAIN

A

PART 1: CLINICAL ASSESSMENT OF CHRONIC PAIN

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2
Q
  • What is the difference between the biomedical and biopsychosocial model?
  • If we take a biomedical approach, we typically see that pain is explained from a _______ perspective.
A
  • Biomedical model has a heavy focus on pathophysiology and biological approaches to disease. Biopsychosocial model takes complex pain issues into account such as psychological and social factors.
  • tissue
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3
Q

Does the biomedical or biopsychosocial model explain chronic pain?

A

biopsychosocial

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4
Q

Which is biopsychosocial and which is biomedical?

  1. ) Anatomy → Biomechanics → Pathoanatomy
  2. ) Biological → Psychological → Social Factors
A 
1 = Biomedical
2 = Biopsychosocial
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5
Q

Biomedical Model:

  • _________ efficacy in regards to pain alleviation and resolution of disability.
  • May result in increased_____, ________, and _______.
A
  • limited efficacy

- fear, anxiety, and stress

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6
Q

Biopsychosocial Model:

  • Fear of movement, pain catastrophizing, anxiety and nervous system sensitization are often ________ of a primary pathology. (Considered main contributors to pain and disability)
  • Treatment for chronic pain that incorporates a ___________ model currently viewed as the most effective approach.
A
  • consequences

- biopsychosocial

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7
Q

What are some psychosocial considerations for individuals with chronic pain?

A
  • Likely have seen several medical practitioners by the time they get to you.
  • Likely have had at least 1 negative encounter with a medical practitioner.
  • Their pain/condition may have been discounted by someone they have encountered.
  • Common that they may have heard several different explanations for their pain, resulting in confusion.
  • Common that these individuals feel a sense of desperation.
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8
Q

Where Do We Begin?:

  • __________ focused assessment (includes both somatic and psychosocial assessment)
  • __________ and ________-___________
  • Includes Pain Neuroscience ___________
A
  • biopsychosocial
  • individualized and patient-centered
  • Pain Neuroscience Education
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9
Q

What are the 3 big components for Screening and Examination?

A
  • Skilled Patient Interview and Examination
  • Screen for Red/Yellow Flags
  • Assessing Underlying Pain Mechanism
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10
Q

PNE should take the individuals pain __________ and ________ into consideration.

A

experience and complexity

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11
Q
  • With a skillful interview we should aim questions to gain a better understanding of the patient’s _________, ________ and _____.
  • List some fundamental questions to ask.
A

-experiences, suffering, and beliefs

  • “What do you think is going on with your back?”
  • “Why do you think you hurt?”
  • “What do you think should be done for your back?”
  • “Where do you see yourself in five years?”
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12
Q

Therapeutic alliance cannot be achieved without __________. _______ and __________ listening are utilized to gain patient trust.

A
  • empathy

- active and reflective listening

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13
Q

What are some things we want to find out that can also help to create a therapeutic alliance?

A
  • How the patient is doing
  • Their perception of their own problem
  • How the problem impacts their life
  • How their lifestyle impacts their problem
  • Identifying patient expectations
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14
Q

Utilization of outcome measures help to measure ________.

A

progress

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15
Q

What are the 2 different types of outcome measures to include when working with this population?

A
  • Functional Outcome Measure

- Outcome Measure Addressing Fear

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16
Q

Functional Outcome Measures Examples:

  • ODI = _______ pain
  • NDI = _______ pain
  • DASH = ____
  • LEFS = _____
  • FAAM = _____
A
  • ODI = back pain
  • NDI = neck pain
  • DASH = UE
  • LEFS = LE
  • FAAM = ankle
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17
Q

What are some outcome measures that address fear?

A
  • Fear Avoidance Belief Questionnaire (FABQ)
  • Pain Catastrophization Scale
  • Tampa Scale for Kinesiophobia
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18
Q

Fear Avoidance Belief Questionnaire about work (FABQ w):

  • Total Possible Points = ___
  • High Score = >___

Fear Avoidance Belief Questionnaire about physical activity (FABQpa):

  • Total Possible Points = ___
  • High Score = >___
A
  • 42
  • > 34
  • 24
  • > 14
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19
Q

Pain Catastrophizing Scale (PCS):

  • What are the 3 distinct dimensions?
  • Score =/>___ indicates clinically relevant level of catastrophizing.
A
  • Rumination, Magnification, Helplessness

- =/>30

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20
Q

Tampa Scale for Kinesiophobia (TSA):

-Score =/>___ indicates patient likely has fear of _______.

A
  • =/>37

- movement

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21
Q

Medical Screening involves looking for ____/______ flags.

A

red/yellow

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22
Q

Red Flags:

  • Looking for patterns to suggest __________ or ________ origin.
  • Do these require immediate medical attention?
A
  • viscerogenic or systemic

- Yes, pursue further screening and make the appropriate referral.

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23
Q

Yellow Flags:

  • __________ barriers to recovery including things such as fear, catastrophization, beliefs, emotions, depression, anxiety, stress, etc.
  • Considered to be main contributors to _____ and ______ and have the potential to increase risk of ____-____ disability and work loss.
A
  • psychosocial

- pain and disability, long-term

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24
Q

Patient Health Questionnaire:

  • PHQ-2 score >/=___ should be further evaluated with PHQ-9.
  • PHQ-9 score >/=___ indicates depression.
A
  • 2

- 10

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25
Q

State Trait Anxiety Inventory:
-Score of >/= __-__ indicates clinically significant symptoms of anxiety.
Older adults Score of ≥ __-__.

A
  • 39-40

- 54-55

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26
Q

Physical Examination:

  • Focus on ________, __________ movements.
  • Discuss results without using “inflated, ____-inducing” words.
  • Focus here again is on enhancing the _________ relationship which aides in patients being more receptive to treatment, including PNE.
  • Include an assessment of general fitness.
  • Include testing for sensitive _________ system if appropriate.
  • May even introduce ____ at this time. (“Has anyone explained to you why you (still) hurt?”)
A
  • global, functional
  • fear-inducing
  • therapeutic
  • nervous system
  • PNE
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27
Q

What is pain neuromatrix?

A

-Widespread brain activity associated with pain experience.

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28
Q

The way we asses pain can actually ignite the pain neuromatrix. What is an example?

A

Using the word “pain”.

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29
Q

What are the 3 pain mechanisms?

A
  • Nociceptive
  • Neuropathic
  • Central sensitization (CS)
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30
Q
  • Ankle sprain = ___________ pain
  • Herniated disc causing radicular pain = ________ pain
  • No Hx of lesion/damage = _________ pain
A
  • Nociceptive
  • Neuropathic
  • Central sensitization (CS)
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31
Q

What are the 2 criteria for CS pain?

A

1.) Perceived pain/disability disproportionate to nature of injury/pathology.
AND
2.) Diffuse/neuro-anatomically illogical distribution OR hypersensitivity present.

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32
Q

What 2 outcome measures may be helpful with patients who we suspect have CS pain?

A
  • Widespread Pain Index

- Central Sensitization Inventory

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33
Q

Widespread Pain Index:

  • Maps pain locations of ___ body regions.
  • Score of __ or greater suggestive of widespread pain.
A
  • 19

- 7

34
Q

Central Sensitization Inventory:

-Cutoff score of ___ indicates possibility of predominant CS pain.

A

40

35
Q

PART 2: INTERVENTIONS FOR CHRONIC PAIN

A

PART 2: INTERVENTIONS FOR CHRONIC PAIN

36
Q
  • Conventional rehab is often time unsuccessful in the chronic pain population. Why?
  • What should be done instead?
A
  • Conventional pain treatment focuses on finding pain-relieving medication or exercise or pain management strategy to manage life with constant pain
  • Use the biopsychosocial approach to provide patient with knowledge, understanding and skills to decrease pain and disability.
37
Q

The _____ __________ shows that there are 2 pathways. Describe these two pathways.

A

Fear-Avoidance Model

  • Injury → Pain Experience → No Fear → Confrontation → Recovery
  • Injury → Pain Experience → Pain Catastrophizing → Pain-Related Fear → Avoidance Hypervigilance → Disuse/Depression/Disability → Pain Experience
38
Q

What is PNE?

A

“PNE aims to explain to patients the biological and physiological processes involved in a pain experience and, more importantly, defocus the issues associated with the anatomical structures.”

39
Q

What does research say about PNE?

A

STRONG evidence show improvements in pain ratings, pain knowledge, disability, pain catastrophization, fear-avoidance, attitudes and behaviors regarding pain, physical movement and healthcare utilization.

40
Q

What are the 3 main components of education?

A
  • Communicate the results of physical examination
  • Educate regarding the nature of the problem
  • “De-educate” prior to “re’educating”.
41
Q

Communicating Results of Physical Examination:

  • Describe in terms that the patient can understand, avoiding the use of the _________ model which may result in increased fear, anxiety and stress.
  • Avoid using terminology that increases ____ and _______. (“tear”, “deterioration”, “herniation”, “wear and tear”, “degeneration”)
  • Establish __________ and set realistic expectations. (complete elimination of pain may not be possible, flare ups are normal)
A
  • biomedical
  • fear and anxiety
  • prognosis
42
Q
  • How to educate about nociceptive pain?
  • How to educate about neuropathic pain?
  • How to educate about central sensitization pain?
A
  • Explain source of nociception and role of the brain.
  • Explain pain neuroscience and underlying neuropathic pain mechanisms.
  • Explain pain neuroscience underlying central sensitization pain.
43
Q

Educate Regarding the Nature of the Problem:

  • PNE is most successful with the use of ______, ______, and ________.
  • What is the “Alarm System”?
  • _________ the pain.
  • Core objective “to shift one’s conceptualization of pain from that of a marker of tissue damage or pathology, to that of a marker of the perceived need to ________ body tissue.”
A
  • metaphors, examples, and pictures
  • A common story used to describe pain.
  • reconceptualize
  • protect
44
Q

With education, what do we want to do before “re-education”?

A

De-educate

45
Q

De-Education:

  • Shift from ________ education mode.
  • Discuss psychosocial barriers if any were identified in the screening examination using ________, _______, and data sharing data to overcome misbeliefs. (40% of individuals with similar “bulging discs” have no pain and continue on with life)
  • Using a _________ approach because there are many factors outside of their pain that can cause issues.
  • Using _________ approach if necessary.
A
  • biomedical
  • compassion, empathy
  • holistic
  • multidisciplinary
46
Q

Principles of Pain Rehabilitation:

  • Observe and listen. Why?
  • Explain Pain’s core objective. What is it?
  • Do we need to avoid pain with our interventions?
A
  • Potential modulators of pain include what we say, do, think, and hear.
  • “To shift one’s conceptualization of pain from that of a marker of tissue damage or pathology, to that of a marker of the perceived need to protect body tissue.”
  • No
47
Q

It is recommended to bill PNE as _______________.

A

Neuro re-education, but be sure to ask billing department.

48
Q

PART 3: INTERVENTION

A

PART 3: INTERVENTION

49
Q

What are the 3 main components of Intervention?

A
  • Individualized POC
  • PNE
  • Multidisciplinary Approach
50
Q
  • Treat the _______, not the ______.

- Chronic pain interventions that incorporates a ___________ model is currently viewed as the most effective approach.

A
  • patient, label

- biopsychosocial

51
Q

What are the 4 pillars of PNE+?

A
  • Pain Education
  • Aerobic Exercise
  • Sleep Hygiene
  • Goal Setting
52
Q

Why PNE+?

A

PNE combined with a physical intervention, such as exercise or manual therapy, is far superior.

53
Q

Summary of PNE Principles:

  • Pain is an _______ of the brain. (Best guess for protection)
  • Pain is not always an indicator of _______ damage.
  • The amount of pain you perceive ________ = the amount of damage.
  • In ________ pain, the brain believes you are in danger and need protecting.
A
  • output
  • tissue
  • doesn’t
  • chronic
54
Q

Exercise:

  • It is important to encourage physical activity as early as possible. Why?
  • Provide frequent ________ that becoming active gradually is safe. (“sore but safe”, “hurt does not = harm”)
  • Implement principles of ______ and _______ Exposure.
A
  • Benefits of physical activity on chronic MSK pain are widely accepted.
  • reassurance
  • Pacing and Graded Exposure
55
Q

What is Pacing and Graded Exposures?

A
  • Pacing- Breaking tasks into manageable portions without exacerbating symptoms.
  • Graded Exposure- Gradually moving towards where pain is at, slowly increasing as we go.
56
Q

Effectiveness of Exercise in Individuals w/ Chronic Pain:

  • PNE combined with exercise or manual therapy is far superior. (Discuss patient _________ of exercise/fears associated with exercise)
  • Unclear whether ________ or ________ exercise is superior in chronic conditions.
  • Exercise induced changes include reduced fear, anxiety & catastrophization, improved self-efficacy, exercise-induced analgesia & positive functional/structural adaptations in the brain.
A
  • perception

- aerobic or resistance

57
Q

What are the current national guidelines on exercise?

A

-150m of moderate intensity activity per week.
OR
-75m of vigorous activity per week.

58
Q

Biopsychosocial Approach to Exercise:

  • Must be perceived as _____ and ___________.
  • May need to temporarily _____/_______ specific activities per patient tolerance.
  • Take caution not to draw frequent _______ to pain.
A
  • safe and meaningful
  • stop/modify
  • attention
59
Q

It is recommended to provide __-__ exercises to do at home.

A

-4-5

60
Q

Principles for Exercise Prescription:

  • Provide the patient with a treatment ________.
  • Establish ______ of activity within first session.
  • Discuss activity ______.
  • Continue to provide patient education (“____-____”).
  • Utilize activity ______/______ to monitor physical activity.
A
  • expectation
  • baseline
  • pacing
  • “flare-ups”
  • tracker/diary
61
Q

What are some consequences of significantly increasing pain during/following 1st session?

A
  • Erode confidence with movement/exercise.
  • Strengthen relationship between movement and pain.
  • Decrease patient motivation for participation.
62
Q

What is “Tease It; Touch It; Nudge It”?

A

Reaching point of pain without going past.

63
Q

Different modes of exercise?

A
  • Aerobic
  • Resistance
  • Land vs Aquatic
64
Q

What are some recommendations for aerobic exercise for this population?

A
  • 20-60m
  • > 2x/week for 6 weeks
  • “Turn down the pain volume or dampen the pain response.”
65
Q

Land vs Aquatic:
-Land-based exercises may facilitate greater improvement in muscle function.
Aquatic program may be necessary for individuals with very poor functional tolerance or heighted pain/distress.
-Ultimate goal is to transition to _____-based program.

A

land

66
Q

Sleep Hygiene:

  • Sleep deprivation is growing problem.
  • Lack of sleep _________ affects wellness and is associated with increased rates of pain, obesity, depression and increased risk for cancer and other health-related disorders.
  • Utilize sleep hygiene education for patients with identified sleep difficulties.
A

negatively

67
Q

Goal Setting:

  • Create a list of __ goals. (“If I could flip a switch and get rid of your pain, what would you do again?”)
  • Patient will likely return with _____ goals.
  • Help the patient develop _______ and _________ goals.
A
  • 5
  • vague
  • measurable and functional
68
Q

4 Simple Tasks for a HEP.

A
  1. ) Questions
  2. ) Exercise
  3. ) Aerobic Exercise Program
  4. ) Goals
69
Q

If the stressors remain present for months, the stress response of increased adrenaline is then followed by __________ changes in the body.

A

cortisol

70
Q
  • Strong evidence to support the use of a __________ approach in individuals with chronic LBP.
  • Key component to successful implementation of multidisciplinary approach is that everyone on the team is utilizing similar language & pain science model.
A

multidisciplinary

71
Q

PART 4: GRADED MOTOR IMAGERY

A

PART 4: GRADED MOTOR IMAGERY

72
Q

What is Graded Motor Imagery (GMI) aimed at?

A

Aimed at cortical reorganization, specifically of primary sensory cortex.

73
Q

What are the 3 parts of GMI?

A
  • Left/Right Discrimination
  • Explicit Motor Imagery
  • Mirror Therapy
74
Q

What Does the Research Say:

  • ___________ effect of mirror therapy and GMI (Based on limited evidence)
  • _____ effect for left/right discrimination.
  • _________ results for stand-alone motor imagery techniques.
A
  • Positive
  • No
  • Conflicting
75
Q

GMI Clinical Pearl:

  • Important to “______ ____ _____” by describing what GMI is.
  • Remind the patient that their recovery requires _________/__________ and _______/_________.
A
  • “prepare the soil”

- patience/persistence, courage/commitment

76
Q

Stage 1- L/R Discrimination:

  • Research demonstrates that left/right discrimination is impaired in individuals with ______ pain.
  • Normalization of left/right discrimination is important for recovery from chronic pain.
A

chronic

77
Q

Stage 1- L/R Discrimination:
Suggestings for Norms from noi group:
-Accuracy = ___%
-Speed = ___s +/- 0.5s for neck/back, ___s +/_ for hands/feet/shoulders/knees
-Maintain above parameters for at least a _____ and despite _______.
-Instructed to make as _______ as possible.
-Easiest to perform at __ degrees and without distractions.
-Repeated __-__x per day.

A
  • 80%
  • 1.6s, 2.0s
  • week, stress
  • quickly
  • 0 degrees
  • 4-5x
78
Q

What are some things that can be modified to make L/R discrimination more difficult?

A
  • Length of display time
  • Number of images
  • Context of images
  • Where it is performed
  • External environment (quiet room verses background noise)
  • Time of day
  • Mood
  • In different postures (lying on floor, sitting, standing up)
79
Q

Stage 2- Explicit Motor Imagery:

  • Imagining movements can be hard work.
  • Time to perform or imagine the task is roughly the same.
  • Important to perform in as many different ______ as possible.
  • Begin with an ___________ body part and work towards the affected area.
  • Goal is to visualize yourself moving but you can begin by visualizing someone else move if it is too difficult.
A
  • places

- unaffected

80
Q

Stage 3- Mirror Therapy:

  • Ensure the mirror is an accurate reflection.
  • Quality mirror at ________ of the body.
  • Remove or cover anything that would identify the limb as right or left (ie rings, tattoos, etc).
A

midline

81
Q

It is important for the patient to ____ exceed the predetermined training load.**

A

NOT

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