pain neuroscience education

is pain considered a global epidemic?

yes

does the US have an opioid problem?

yes

have drug overdose deaths been increasing or decreasing?

decreased by 4% from 2017 to 2018

what is pain?

- unpleasant sensory and emotional experience associated with actual or potential tissue damage

T/F: pain is multi system output?

true

what is acute pain?

- pain related to an underlying health condition lasting less than 6 months

what is chronic pain?

- pain lasting longer than 6 months and is now independent of the underlying health condition

what is normal maximal healing time for most tissues?

3-6mo

what is the biomedical model for chronic pain?

- standard for health professions

- fault and fix

- anatomical and biomedical faults

T/F: people with chronic pain become fascinated with their pain and need to prove that there is something wrong with them?

true

is hopelessness often associated with acute or chronic pain?

chronic

is traditional biomedical education effective?

- ineffective

- may reenforce negative pain behaviors

what is pain neuroscience education

- educate people about their pain

do you or your patient need to know more in terms of pain neuroscience?

- your patient only needs to know the tip of the iceberg

- you need to know much more

T/F: pain used to be associated with religious beliefs or as a punishment from a diety?

true

what is the cartesian model?

- body was a machine and pain was a disturbance passed down along nerve fibers until it reached the brain

- Descartes, treatise of man

where was it once believed that pain resided in?

the heart

what is the cartesian model treatment options?

- take your foot out of the fire --> don't do things that cause your pain

- put out the fire --> opioids

- cut the wire --> surgery

what is gate control theory?

- bottom up approach

- primary pain seen as an overstimulation of various receptors

- "gating mechanism" exists in the dorsal horn of the spinal cord

what are limitations to gate control theory?

- phantom limb pain

- pain below LOI in complete SCI

is gait control theory still relevant?

- yes

is pain neuroscience education a bottom up or top down approach?

- top down

what is mature organism model?

- pain neuroscience education

- multiple items may affect the pain experience

> tissues and anatomical influences

> blood supply to nervous system

> past experiences

> beliefs/culture

what are the 3 key elements of mature organism model

- input mechanisms

- processing mechanisms

- output mechanisms

explain how pain is in the brain?

- asymptomatic people will have pathologies on imaging

is pain correlated with stages of healing?

no

what are ion channels?

- regulate the flow of ions across the membrane in all cells

- opening and closing are controlled by different signals

explain ion expression if there is no threat being faced towards an organism?

- equal expression of each ion channel

T/F: ion channels are constantly changing?

true

what is the halflife of an ion channel?

- 48hours

- allowing for constant neuroplasticity

what controls ion expression?

- genetic coding ensures some predetermined ion channel expression

- changes based on what the brain thinks we need to survive

is sensitivity constantly changing?

yes

where are areas that have higher concentration of ion channels?

- areas with less myelin (dorsal root ganglion, nodes of ranvier)

can nerve injuries cause loss of myelin? will this increase or decrease ion channels?

- yes

- increase concentration of ion channels

how is myelin removed? (3)

- mechanical force

- immune processes

- chemical stripping

do high or low concentrations of ion channels cause pain? why?

- high [ ] ion channels cause pain due to threats

brain, SC, and PNS account for _____% total body mass? consumes ____% available oxygen in blood?

- 2-3%

- 25%

is sensitization of our nervous system related to blood flow? how?

- yes

- when blood flow decreased, sensitivity increases

- when blood flow increased, sensitivity decreases

role of interneurons

- relay neurons that form connections between other neurons

- not sensory or motor

difference between primary afferent and second-order neurons?

- primary afferents go from stimulus to the presynaptic terminal

- second order neuron take it to the brain to process the information

what is an action potential wind up?

- increase in action potentials causes this

- persistent input from peripherals changes the second order neurons and brain pathways

- causes heightened sensitization

what causes low pain thresholds?

- interneuronal death lowers the thresholds so that they are more easily met

where are nociceptive inputs recieved?

- primarily by the thalamus

are there specific pain areas of the brain?

- no

- in chronic pain, some areas are overcome by pain

where is information sent in the brain with chronic pain?

- to emotional areas

does the homunculus change with chronic pain?

- yes

- cortical restructuring --> can cause cortical smudging / unable to clearly identify a part of the body

when is pain produced by the brain?

- when the brain concludes there is danger

T/F: it is possible to have pain and not know about it?

true

T/F: when part of your body in injured, special pain receptors convey the pain message to your brain

true

T/F: pain only occurs when you are injured or at risk of being injured?

false

T/F: when you are injured, special receptors convey the danger message to your spinal cord?

true

T/F: nerves adapt by increasing their resting level of excitement?

true

T/F: chronic pain means that an injury hasn't healed properly?

false

T/F: worse injuries always result in worse pain?

false

T/F: descending neurons are always inhibitory

false

T/F: when you injure yourself, the environment that you are in will not affect the amount of pain you are experiencing as long as the injury is exactly the same?

false

T/F: the brain decides when you will experience pain?

true

what are the 4 habits model?

- invest in the beginning --> create rapport

- elicit the patients perspective --> ask for their requests

- demonstrate empathy --> be open to their emotions

- invest in the end --> provide education and include the pt in CDM

do you use PNE with everyone?

no

why is it important to follow a top-down approach?

- decrease pain catastrophizing and increase pain knowledge

- will activate naturally occurring opioids and cannabinoids

why is it important to follow a bottom-up approach?

- gate control theory

- alter C-fiber activity in the CNS to decrease the threat that the brain feels which is eliciting pain

so should you do bottom-up or top-down?

both

should you use patho-anatomical explanations and visuals/models?

no

what age level should you teach patients at?

5-6th grade

should you use metaphores?

yes

what is placebo effect?

- patients may improve while receiving a harmless treatment that is without therapeutic benefit

what is a nocebo effect?

- patients symptoms worsen after receiving a harmless treatment without therapeutic benefit

is the use of placebo and avoidance of nocebo to replace medicine?

- no, want to enhance it