Wk 1: Pain/Pain Management + Inflammation/Tissue Healing

What is the clinical definition of inflammation?

The first occurrence in the tissue healing sequence that begins when normal physiology is altered by disease or trauma.

What are the two primary goals of the acute inflammation phase?

To eliminate the pathological insult and promote the regeneration of normal tissue structure.

How does the absence of inflammation affect the overall tissue healing process?

Healing cannot take place if no inflammation occurs.

What is the specific role of platelets during the inflammation phase?

To block off or coagulate the injured area.

Which specific type of cell is responsible for fighting off infection during the early stages of healing?

Neutrophils.

What is the primary function of macrophages in the inflammation phase?

To remove dead cells from the injured site.

List the five cardinal signs of inflammation.

Heat, redness, swelling, pain, and loss of function.

Term: Hyperemia

Definition: An increase in blood in a given area, often caused by vasodilation during inflammation.

Under what condition does inflammation become harmful to the body?

When it is chronic, directed at the wrong tissue, or excessively exuberant (e.g., autoimmune diseases).

How does chronic inflammation such as Rheumatoid Arthritis (RA) affect joint health?

It acts as an inappropriately directed reaction that can damage and destroy joints.

What cellular change occurs during chronic inflammation that leads to increased scar tissue formation?

Increased fibroblast proliferation, which results in higher collagen production.

The inflammation phase typically occurs during which timeframe following an injury?

Days $1$ to $6$.

The proliferation phase typically occurs during which timeframe following an injury?

Days $3$ to $20$.

What is the primary goal of the proliferation phase regarding the wound site?

To cover the wound and impart strength to the injury site.

Term: Neovascularization (Angiogenesis)

Definition: The process of forming new capillaries/blood vessels during the proliferation phase.

What is the estimated tensile strength of injured tissue during the proliferation phase compared to normal tissue?

As low as $15\%$.

Why is it important to avoid 'overuse' during the proliferation phase of healing?

The newly formed tissue is fragile and tensile strength is very low.

When does the maturation (remodeling) phase typically begin and how long can it last?

It begins around Day $9$ and can last between one to two years.

What visual cue indicates that remodeling is still occurring in a scar?

The scar appears redder or darker than the surrounding tissue.

How does early controlled movement affect the final tissue structure during the maturation phase?

Internal and external stresses determine the fiber orientation to mimic pre-injured tissue.

Why might dense tissues be more likely to form 'adhesions' during healing?

Dense tissue induces a highly cross-linked scar that may result in poorly gliding tissues.

How does the size and type of wound affect the speed of the healing process?

Smaller wounds and surgical incisions heal faster than large wounds or blunt trauma.

What is considered the most problematic local factor that can delay the healing process?

Infection.

How does ischemia (decreased oxygen) specifically impact cellular activity in healing?

It inhibits fibroblast migration and reduces collagen synthesis.

Which category of medical interventions includes cryotherapy, thermotherapy, and ultrasound?

Physical agents (external forces).

Pain is defined as both a sensory experience and an _____ experience.

Affective

What are the two anatomical divisions of the human nervous system?

The Central Nervous System (CNS) and the Peripheral Nervous System (PNS).

Which components make up the Central Nervous System (CNS)?

The brain and the spinal cord.

How does 'Pain' differ from 'Nociception' according to the International Association on the Study of Pain?

Pain is a conscious brain perception, while nociception is the neural process of encoding a noxious stimulus.

List the three types of noxious stimuli that can trigger nociception.

Mechanical, chemical, and thermal.

Is it possible for a person to experience pain without any peripheral nociceptive input?

Yes, pain can be experienced without any peripheral nociceptive input at all.

What are the three stages of the 'Vicious Pain Cycle'?

Pain $\rightarrow$ Spasm $\rightarrow$ Ischemia.

How does ischemia contribute to increased pain perception in the body?

Reduced blood flow decreases oxygen and nutrients, which increases noxious stimuli messages sent to the brain.

A PTA is treating a patient with 'acute' pain; what is the expected maximum timeframe for this classification?

The first $6$ weeks.

What is the common timeframe used to define pain as 'chronic'?

Pain that has lasted longer than $3$ to $6$ months.

Name two psychosocial factors often associated with the chronic pain cycle.

Depression and psychosocial stress.

How does chronic pain typically affect a patient's physical posture?

It often leads to a 'guarded posture.'

Term: Dermatome

Definition: An area of skin that is innervated by a specific nerve root.

Term: Myotome

Definition: An area of muscle innervated by a specific nerve root.

Term: Hyperalgesia

Definition: Excessive sensitivity to pain, often caused by damage to nerves.

Term: Allodynia

Definition: Pain experienced due to a stimulus that does not normally provoke pain.

Term: Analgesia

Definition: The loss of pain sensation resulting from an interruption in the nervous system pathway.

What are the common characteristics of visceral pain?

It arises from deep body structures, is difficult to localize, and may be felt at a distant site.

What physical characteristic defines a 'Trigger Point' upon palpation?

A palpable nodule that is locally tender when compressed.

According to the Gate Control Theory, where is the first site in the CNS where nociceptive signals are integrated?

The dorsal horn of the spinal cord.

How does the Gate Control Theory explain the inhibition of pain transmission?

Nonpainful (non-nociceptive) stimuli can inhibit pain signals at the spinal cord level to 'close the gate'.

Which physical agents are commonly thought to 'close the gate' to pain transmission?

Cryotherapy, thermotherapy, electrical stimulation, and traction.

What are the three main priorities of pharmacological acute pain management?

Modify inflammatory mediators, alter pain transmission, and alter central perception of pain.

Which common medication is an example of an analgesic without anti-inflammatory properties?

Acetaminophen (Tylenol).

List three common over-the-counter NSAIDs used to modify inflammatory mediators.

Aspirin, ibuprofen (Motrin/Advil), and naproxen sodium (Aleve).

What does the acronym RICE stand for in acute pain management?

Rest, Ice, Compression, and Elevation.

In the RICE protocol, what is the specific physiological goal of using ice?

To reduce pain by reducing inflammation and peripheral sensitization in the tissues.

What is the primary purpose of applying compression and elevation according to non-pharmacological principles?

To reduce edema.

Why is 'Rest' included as a priority in the early phases of tissue healing?

It allows damaged tissues to heal without further insult.

How should a PTA use communication to help prevent the development of chronic pain?

By providing reassurance and minimizing messages that might exacerbate a patient's fear.