MSK III Pain Science

Objectives

1. Understand the basic physiology of pain science.​

2. Explain how current literature on pain science differs from the paingate theory.​

3. Understand the role of language and trauma informed care alongside PNE.​

4. Implement appropriate pain neuroscience education within a case simulation.​

5. Understand and interpret the findings of the CSI​

Pain

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” ​

which theory are we moving away from?

the pain gate theory

100% of the time pain comes from the ______ as a response to actual or _________ tissue ________

100% of the time pain comes from the brain as a response to actual or perceived tissue damage

• analogy

  • pain is like an

  • during healing, the alarm system becomes more

    • ex:

  • this is normal

• however, it is not normal when the nervous system is still super

  • like at 6

• pain is worse when

• the threshold for signaling pain has

• analogy

  • pain is like an alarm system on a house

    • like for a burglar breaking in

  • during healing, the alarm system becomes more sensitive because it doesn’t want more damage —> might go off for potential damage

    • ex: the mailman

  • this is normal

• however, it is not normal when the nervous system is still super sensitive way past the tissue healing time.

  • like at 6 months, when tissue healing has occurred

• pain is worse when stressed out

• the threshold for signaling pain has decreased and is easier to trigger

what can occur with chronic pain?

• “smudging”

• areas close together can blur or smudge due to chronic pain

  • difficulty with differentiation of pain, especially with areas closer together

  • pain becomes more diffuse

Fundamental shift​

• Pain is 100% produced in the brain​

• Injury and pain are two different things​

• Pain is meant to be protective ​

  • Preemptive pain in response to perceived threat​

The pain neuromatrix

there are 11 areas of the brain that are illuminated every time you’re in pain

Central Sensitization​

• diagnosis of exclusion

• someone’s NS is so chronically revved up that their pain does not seem to make much sense to us

• CSI ≥ 40

• measurable biological AND physiological change

• metaphors:

  • house alarm system

  • sunburn

The impact of language in musculoskeletal rehabilitation

• Words to avoid

• Alternatives

• Words to avoid

  • chronic degenerative changes

  • instability

    • this should only be used to describe red flags like sublux/dislocation or conditions like spondylolisthesis

  • wear and tear

  • bulge/herniation

• Alternatives

  • normal age related changes

  • needs more strength and control

  • normal age changes

  • bump/swelling

*using the wrong language during pt education could actually cause more stress and pain

Common negative & faulty pain beliefs​

• Unstable= fragile= risk of falling apart​

• Pain = tissue damage​

• Negative MRI = Crazy​

• Positive MRI= pain forever​

• “I know I have pain, it’s there, I just can’t feel it right now.”​

  • Me: “So, your pain is a 0/10 at the moment?”​

  • Them: “I wouldn’t say that, let’s call it a5/10”​

Pain Science Treatment ​

1. Laterality training ​

   1. helps them localize

2. Tactile discrimination

   1. draw on their back, hand them image of spots on a person’s back and ask them to identify location

   2. bring spots closer together over time

3. Imagined movements/graded motor imagery​

   1. retraining nervous system

   2. can be part of HEP

   3. not actually happening, show them it is safe

4. Mirror Therapy ​

​

• Language! ​

1. Trauma informed care​

2. Motivational Interviewing​

3. Education​