VCU DPT - Clinical Medicine (Pain Neuroscience Education Week 3)

biomedical approach around medical therapy says if there is a lot of pathology (aka stiffness), there is a lot of _________

does this hold up with OA?

symptoms

- doing a manip/mob where you decrease stiffness will decrease sx

no

degree of OA and symptoms not aligning, joint replacement not decreasing pain, and patients having central sensitization is an argument AGAINST the _____________ model

biomedical

- it says more pathology, more pain you have

t/f: acute pain might be appropriate to be address using biomedical model, whereas chronic is not so much

t

palpating for alignment, decreased motion, and pain to then improve alignment/motion might not be ___________

effective

why did 1/5 patients in the SKOU study have no change in pain or worsening pain following TKA?

maybe because central sensitization played a role in it

SKOU

those who got a revision surgery on their TKA knee and had pain, compared to those without pain, reported less pressure to pain at which of the following sites:

a) peripatellar

b) tibialis anterior

c) forearm

all of them!!

- all had less pressure to pain in every spot if had pain in knee

more going on than just the knee- central sensitization!!

SKOU

a) t/f: there may be widespread sensitization in pts with chronic knee pain after TKA, suggesting perip and central sensitization mechanisms in chronic knee OA pain. May suggest precautions for future surgical knee interventions

b) what does this means for deciding to do a surgery or not

a) T

b) might want to screen for other reasons of pain in knee before doing another surgery, as the knee might not be sole cause of pain but instead central

- which if the case, no surgery will help

manual therapy may

a) ______ pain expectancy

b) ______ fear of movement

c) ______ brain response

a) decr

b) decr

c) change

can manual therapy activate natural brain pain mechanism?

YES!!!

can manual therapy be used as a prelude for more active approaches?

YES

what are some limitations of manual therapy (and biomedical model) (3)

any motion changes are transient

effects do not last super long

palpation is often unreliable

are nerve based techniques specific to moving nervous tissue alone?

no

is joint mobs dissipated over small area or large area

often large

during a ______________, it works because of

BOTH

local physiological mechanisms

AND

central mechanisms (activation of inhibitory pathways in SC and descending inhibitory in brainstem

mobilization

do patients consider touch important? what about therapeutic alliance?

YES

- both

TA is when patient feels that the PT is on pts side

with dry needling/soft tissue massage, something that impacted the rates of patient improvement was their ______________ going into it

EXPECTATIONS

t/f: patient expectations may influence treatment, independent of treatment itself

t

in randomized control trials, we have a control group. if our study shows that the group we are looking at is not effective, this meant it was no better than placebo.

does this always mean it was bad?

No

might just mean placebo was effective too

manual therapy is less effective when patient is in a ______ mood

BAD

studies show that pain education in addition to _________________ was more effective than traditional PT only

traditional PT inteventions

LOUW

this study looked at manual therapy + either neuroplastic education or mechanical education

results showed potential area for more research, and leads us to think that PNE may _________ effect of manual therapy interventions

ENHANCE

can our hands ALONE being on the patient improve their perception of pain?

MOSS

yes!!

although better to give actual intervention, really just having hands on showed to be beneficial

PTs can help treat ___________ by utilizing both

locally applied physical treatments (manual, targeted exercise)

AND

central non-physical treatments (PNE)

central sensitization

manual therapy would show improvement in asterik sign when the pain cause is _________

would not show improvement if pain cause is _________

local tissue/inflammation

knee AND nervous system

- here, would need PNE

should PNE be hands on or hands off

BOTH

bc combine manual therapy with it

t/f: graded mobs not to get joint moving, but to gradually calm NS down

t

many constant questions about pain can disrupt our PNE target, which is on __________

function

helping patient focus on increased proprioception (at least with lower back pain), might help __________ ROM and ______ pain

incr

decr

can manipulation change fear of movement?

YES

- may help decr fear

LLUCH

which is better first, PNE or Manual therapy?

and why?

PNE before MT

because patient now has education and changed idea of pain before manual, so less threatening danger messages with MT and more success with it and exercise

__________ is increased pain sensitivity to normally painful stimulus

********

hyperalgesia

*******

______ is a painful response to non-nocioceptive stimulus

***********

allodynia

*******

what is algometer used forq

to measure pressure pain threshold

biomedical explanations (pain due to injury/alignment/wear and tear.posture) can _______________ fear in patientsq

INCREASE

symptom modification test's goals are to ???????

decrease fear

change movement pattern

what is symptom modification tests?

things you do to help the patient move better without pain, using high reps and high frequency

ex: scapular assist