PT Assessment of Pain

Flashcards covering the assessment of pain in physical therapy, including subjective exam strategies, pain mechanisms, and objective tests for sensitized patients.

Therapeutic Alliance (TA)

A key relationship established during the Subjective Exam, particularly crucial when working with patients possessing persistent or complex pain.

External Locus of Control

Treatments or interventions to decrease pain that are performed by a healthcare provider upon the patient, such as surgery, injections, manual therapy, dry needling, or medication.

Internal Locus of Control

Methods to decrease pain that are performed by the patient themselves, such as exercise, mindfulness, or breathing exercises.

Nociceptive-dominant Pain Mechanism

Pain classification characterized by clear aggravating and easing factors related to loading/strain, intermittent sharp/aching descriptors, and the absence of neurological symptoms.

Peripheral Neuropathic Pain

Pain characterized by dermatome and cutaneous referral patterns, often accompanied by symptoms such as numbness or pins and needles.

Central Mechanisms (Nociplastic)

A pain state involving widespread pain, inconsistent aggravating factors, latent pain from small movements, and psychosocial issues like fear-avoidance or catastrophizing.

Nociceptive Provocation (Objective Exam)

Pain provocation (e.g., palpation or movement) that is specific only to the affected area and does not trigger symptoms in remote or uninvolved areas.

Central Sensitization Provocation (Objective Exam)

Pain provocation in an affected area that is likely to trigger symptoms in another remote area, such as the opposite limb, indicating widespread mechanosensitivity.

Inert Tissue Pattern

Clinical findings where Active Range of Motion (AROM) equals Passive Range of Motion (PROM), end-range pain occurs in the area moved toward, and resistance is strong and painless.

Contractile Tissue Pattern

Clinical findings where AROM is less than PROM, pain occurs in the area moved toward, and resistance is weak and painful.

Pressure Pain Threshold (PPT)

An objective mechanosensitivity test where pressure is applied gradually at $\text{1 kg/s}$ via an algometer until the patient signals the sensation has changed to pain.

PPT Minimum Clinically Important Difference (MCID)

The threshold for a meaningful change in Pressure Pain Threshold testing, which is recorded as $15\%$.

Order of Movement Principle

A modification strategy for neurodynamic testing used for sensitized individuals to ensure the test is tolerated and valid.

Empty End-feel

In central sensitization, this occurs when pain ($P2$) is felt before tissue resistance ($R2$), or guarding/spasm ($S2$) prevents the assessment of the true end-feel.

Exercise-Induced Hypoalgesia Intensity

The ideal intensity for endogenous opioid release and pain modulation is $70\%-80\%$ (Z3), though sensitized patients may start at $50\%-60\%$ (Z1).

Karvonen Formula

Calculates exercise intensity: $\text{Lower \& Upper Limits} = (\%\text{Intensity} \times \text{HRR}) + \text{RHR}$, where $\text{HRR} = \text{HR}_{\text{max}} - \text{RHR}$.

Laterality

A neuroplasticity test involving left/right judgment of body parts, where hand/foot norms are typically $80\%$ accuracy within $1.5-2.5\,\text{sec}$.

2-point Discrimination (TPD)

A neuroplasticity test assessing the ability to discern two distinct points touching the skin, which can be distorted in patients with central/nociplastic pain.

Localization

A test for sensory neuroplasticity where a patient identifies which square on a grid is being touched; $80\%$ accuracy is used as a common reference point.

Central Sensitization Inventory (CSI)

A specific patient-completed screening tool used to identify and classify central sensitization.

NPQ (Pain Knowledge Questionnaire)

A tool used to assess a patient's understanding of pain to help physical therapists target Pain Neuroscience Education (PNE).