Pain (LM) : Final

What is a pain pie?

how much % the three dominant pain mechanisms make up a patient's pain

illustrates the mulifactoral nature of pain by breaking it down into 3 dominant pain mechanisms

pain pie

the relationship that is created between PT and patient; a predictor, mediator and part of the treatment effect in PT rehab

therapeutic alliance

expectations of treatment effectiveness predict its success in reducing pain

patient expectations

Why is the therapeutic alliance and expectancy effects important?

affect how successful the patient is in recovery

promotes pain relief and well being without triggering inflammatory flare via neurogenic inflammatory

graded approach to increase functional activity

What are active interventions to help decrease pain?

promote quality sleep, aerobic exercise, isometric exercise

True or false: as a PT, you must adapt and be able to change treatment plans and interventions based on patient needs

true

What are methods used by higher performing PTs?

active treatments, manual therapy, fewer modalities

What types of patients should be treated more cautiously and conservatory because their symptoms are easily provoked and may take a while to calm down?

higher severity and irritable

True or false: lower severity and less irritable patients can be treated more aggressively with less modalities and more strength training

true

pain greater than or equal to 7/10, constant pain and/or night pain; high disability; more pain with AROM than PROM

high irritability

pain greater than or equal to 4-6/10; intermittent pain and/or nigh pain; moderate disability, equal pain with AROM and PROM

medium irritability

pain less than or equal to 3/10, no pain at rest or night pain; low disability; pain only with PROM with overpressure

low irritability

Peripheral pain inhibition effects

improved pain pressure thresholds

improved pain pressure thresholds at distant sites

central inhibition

change in brain area activation (reduced cortical activation post manipulation; thought to have reduced pain circuit acitvation)

cortical pain inhibition

What level could manual therapy have mechanisms acting at?

peripheral, segmental spinal, and supra spinal levels

joint position changes, tissue movement, fluid loading

biomechanical loading

changes in neural conductivity/conduction

neurological

inflammatory and anti-inflammatory mediator changes

Neuroimmune

ANS response, Blood flow changes locally and remotely

neuromuscular

changes in neurotransmitter and neuropeptide levels

neurotransmitter and neuropeptide

changes in endocrine markers

neuroendocrine

changes in muscle tone, muscle activation

neuromuscular

create mechanical tension: Proximal and distal positions of tension "nerve stretch"

tensioners

high irritability is usually?

nociplastic or acute/nocieptive pain

True or false: manual therapy increases central sensitization and promotes ascending inhibition of pain

false - decreases central sensitization and promotes descending inhibition of pain

What is a SLR commonly used for?

lumbar disc pathology; good for ruling out : negative= ruled out disc

move one end while slackening the other

sliders

true or false: LBP is effective in relieving pain and improving disability for short term

true

What origin of pain can a neurodynamic test for LBP help?

neural origin

True or false: neurodynamics are always effective for neck pain

false- can help, but not always

What condition is there inconsistent results for neurodynamics?

CTS

What dictates choice of manual therapy & neurodynamic treatment?

dose and intensity (low load, low reps first), patient understanding

What are the stages of the SINSS model?

severity, irritability, nature, stage, stability

how can stability from the SINSS model be described?

better, worse, unchanged

sciatic nerve problem

sciatica

spinal nerve root pathology

radiculopathy

spinal cord pathology

myelopathy

primary pain originating from different source/location

referred pain

give an example of referred pain

jaw pain from a heart attack

What are the most important factors to consider in exercise dosing/prescription in PT?

dominant pain mechanism, injured tissue, symptom irritability

What effect does a sedentary life style have on central inhibition and central facilitation

reduces central inhibition, increases central facilitation

True or false: a sedentary lifestyle impacts more of the inflammatory system

true

How does an active lifestyle affect central inhibition and central facilitation

increase central inhibition and decreases central facilitation

True or false: a sedentary lifestyle can be protective and prevent the development of chronic pain

false - physical activity

What exercise would you prescribe for nociceptive pain ?

long hold isometrics

What are you treating if a patient is experiencing neuropathic pain ?

the nerve

What does a nerve need?

movement, space, blood

what would you prescribe for a patient who has nociplastic pain?

graded exercise/activity

What type of exercise is appropriate for ALL 3 types of pain mechanisms and should be incorporated into every PT HEP?

Aerobic exercise

How is sleep related to Pain?

disordered sleep can reduce pain inhibition (increases pain perception)

True or false: reduced sleep could decrease risk for developing pain

false - increase risk

True or false: you can have pain while sleeping

false

How much sleep is recommended for adults per night?

7-9 hrs

time to fall asleep; ideally 0-30 min for all ages

sleep latency

what is the ideal sleep efficiency for all ages?

85%

What are good practices for sleep hygiene?

consistent wake/sleep schedule; no electronics 1-2 hrs before bed, no exercise, large meals, caffeine/ stimulates, bed is for sleep and sex, limit drinking and smoking

How can a poor diet / nutrition affect chronic MSK pain?

contribute, maintain, prevent recovery

what meds could help treat nociceptive pain?

topical analgesics, Saids, opioids, channel blockers

examples of drugs for nociceptive pain

aspirin, Tylenol, ibuprofen, aleve

What types of drugs can treat neuropathic pain?

gabapentin

What is a therapeutic dose of gabapentinoids?

900-3600 mg a day split over 3-4X daily

What conditions could a gabapentinoid be used to treat?

Diabetic neuropahty, post heperctic neuralgia

True or false: Gabapentinoids can be prescribed for Chronic LBP, sciatica, spinal stenosis, migraines, or acute post op pain

false

What types of drugs can be prescribed for nociplastic pain

SNRI, tricyclic antidepressants

Signs of a UMN lesion

hyperreflexia and hypertonia

what spinal tract is responsible for voluntary motor contractions?

corticospinal tract

How does UMN damage affect LMN?

UMN inhibitory influence on LMN is lost leading to overactivity of spinal reflexes

Signs of LMN dysfunction

hypotonia; hyporeflexia

True or false: LMNs are directly responsible for eliciting the reflex response

true

stoke on the lateral plantar side of the foot, big toe extends

babainski

flick distal phalanx of middle finger causes the thumb and index finger to flex

hoffmann

What are sings of UMN lesions?

babinski, hoffmann, clonus

Light touch, fibrin, and dynamic mechanical are?

a beta fiber activation

pin prick or cold/warm are?

A delta and C fiber

measure of central inhibitory mechanisms following painful stimuli application

conditioned pain modulation

examples of high intensity aerobic exercise?

running, rowing, HIIT

examples of low intensity aerobic exercise?

walk/jog, bike, swim, light yoga

How to bring more blood to the nerve?

aerobic exercise, massage

How to give a nerve more movement?

glides, tensions, UE/LE AROm

How to give a nerve more space?

stitching, mobility drills, lumbar/cervical traction, joint mobs

What type of patients is graded motor imagery good for?

nociplastic patients

What should gabapentinoids not treat?

chronic LBP, sciatica, spinal stenosis, acute post op, migraines