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211 exam 2
Chronic pain
| Question | Answer |
|---|---|
| pain definition | an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage |
| types of pain | acute neuropathic nociceptive nociplastic |
| acute pain | Break your finger Burn your hand actual biomechanical damage |
| neuropathic pain | Nerve injuries: Limb amputation Neuropathy |
| nociceptive pain | Pain due to damage to tissues: Sprained ankle Muscle strain |
| nociplastic pain | Pain that does not correlate with biomechanical changes in tissue |
| what qualifies as chronic pain | pain lasting longer than 3 months, 6 months by some definitions |
| biomedical model of pain | physical therapy model of pain (biomechanical model) we treat the "pain generators" this model discounts the psychological aspects of pain |
| biopsychosocial model of pain | looks at what causes chronic pain includes biological(drugs, genetics, co-morbidity) , social ( work situation, ADL's) , and psychological factors (coping, stress) |
| gate control theory | Stimulating A-beta interneurons to inhibit pain signals to the brain |
| A beta fibers | inhibitory neurons for pain |
| A delta fibers | acute pain |
| C fibers | chronic pain |
| central sensitization "wind up syndrome" | pain fibers are added to interneuron forming wind up nerve that amplifies pain signal (pic 14) |
| There are many similarities between the effects of chronic pain and ____ on the brain | depression |
| Sensory pathways for chronic pain and depression both include what parts of the brain? | insular cortex, prefrontal cortex, anterior cingulate, thalamus, hippocampus, and amygdala |
| role of cortisol | positive response to pain and stress maladaptive response to pain and stress |
| cortisol as a positive response to pain and stress | Anti-inflammatory Mobilizes glucose reserves Helps to ingrain pain memories |
| cortisol as a maladaptive response to pain and stress | If responses to stress are exaggerated, then we stay ramped up |
| HPA axis (slide 17) | |
| what are pain behaviors | Any behavior that draws attention to the fact that the person is experiencing pain |
| problem with pain behaviors | Often produce secondary problems that add to the pain such as muscle imbalance, poor posture and body mechanics |
| types of pain behaviors | Postural Facial Verbal |
| barriers to recovery and return to work | Express unrealistic fears about returning to work, doing exercises, or being re-injured Receive secondary gains from disability Lawsuit pending or patient talking a lot about their claim Poor employee/supervisor relationship |
| disciplines at pain rehabilitation clinic | Interdisciplinary team approach (ideally) BT, OT, PT, Voc., Psychologist, Physiatrist, Case Manager, Dietician, Chaplain VRC, Nurse Case Manager, Insurance Claims Manager, Employer |
| major funding for pain rehab programs | Washington L&I, employer self-insurance |
| timeline for Pain/Industrial Rehabilitation Programs | 3-week clinic, 5 days per week, approx. 8 hours per day similar to their normal work hours |
| chronic pain pts tend to be very deconditioned and have more _____ problems | emotional/behavioral |
| content included in industrial pain rehab | classroom lectures: posture, spinal anatomy, physiological pain cycle, disc pressure, body mechanics, work simplification, activity modification, time management, family group, assertiveness training, stress management, sex, medications, nutrition |
| follow up clinic after industrial pain rehab | Part II of Pain Clinic lasting for 3 weeks Less focus on classroom lectures, more focus on increasing strength, endurance and physical capacities Most motivated and with ongoing vocational goals are recommended |
| Industrial Rehab or Pain Clinics referral indicators- pain symptoms | Lasting 2 months or longer Severe and persistent Non-responsive to traditional methods of treatment and pain relief such as bed rest, heat/ice, traction, massage, US, stretching, light exercise |
| Industrial Rehab or Pain Clinics referral indicators- physical findings | Minor to moderate Do not match/justify subjective complaints Sometimes no neurological signs or problems |
| Industrial Rehab or Pain Clinics referral indicators- activity level | markedly reduced or widely fluctuating (crash and burn) |
| Industrial Rehab or Pain Clinics referral indicators- significant lifestyle disruption | vocational, social, marital and recreational |
| Industrial Rehab or Pain Clinics referral indicator- sleep disturbances | problems with stage 4 sleep and production of growth hormone |
| Industrial Rehab or Pain Clinics referral indicator- behavioral problems | increased Anxiety, depression, anger History of physical, mental or sexual abuse Poor emotional coping abilities History of substance abuse |
| work hardening program | specific 4 week program, 4-7 hours per day, 5 days per week |
| primary goal of work hardening program | return to work, specified prior to beginning |
| what does work hardening program include | some lectures, more exercise, job stations, work simulation, coaching, worksite eval |
| work hardening pt vs pain rehab clinic | more physically active, fewer behavioral problems and fewe barriers to return to work |
| main focus of work hardening | developing physical abilities and activity modification and working within one's functional activity level |
| work conditioning vs work hardening | similar to work hardening, but vocational goal may not be identified |
| how long does work conditioning last | 2 hours per day, may be as many as 5 days per week, may last for several weeks |
| physical capacity evaluations (PCE's) | comprehensive one day evaluation includes assessment of strength, coordination, ROM, sit, stand, walk tolerance, lift/carry ability, squat, crawl, balance, body mechanics, posture, hand strength |
| what may PCE's test | general abilities of specific skills test pt pr against specific job analysis to determine job readiness |
| best return to work scenario | return to job of injury |
| L&I return to work options | return to job of injury return to job of injury with job modifications return to work with different employer in different job due to transferable skills retraining for one year |
| how much does L&I pay an injured pt? | 60-70% + medical – doesn’t encourage patient to get off system. |
| Studies show that employees who stay out of work with a job-related injury for more than twelve weeks have less than a ___% chance of ever returning | 50 |
| benefits of getting employees back to work after an injury | reduce claim cost worker keep positive connection to work save cost of training new employee promotes good moral throughout practive keep employees mentally and physically acclimated to work sched speed up healing process |
| common treatment goals | Return to work increase strength, endurance, ROM Improve posture and body mechanics Improve patient’s self-management of pain decrease pain behaviors decrease use of pain meds Ergonomic worksite recommendations |
| Waddell sign | Nonorganic or psychological tool |
| components of waddell sign | 1. Tenderness – nonspecific 2. Simulation test – tests nonspecific to dx 3. Distraction test – ask to do routine task 4. Regional Disturbance – unexplained widespread dysfunction 5. Overreaction 3/5 positive |
| education for chronic pain pts | It’s not in your head (sort of)- PNE – pain neuroscience education |
| therapeutic relationship and tx | Make sure the patient feels heard Listen to their story Believe them and let it show Articulate your thoughts out loud Give patient choices Make sure to establish a therapeutic alliance Set goals with patient Impaired function |
| therapeutic relationship and tx cont. | Be honest—pain may not go away, but it doesn’t have to be in charge. PT benefits will take time Encourage movement, albeit slowly Push the pain boundary Soreness is okay—you are still safe Involve Mental Health practitioners if needed |
| tx guidelines for chronic pain pts | Redraw the pain line Graded movement Exercise at a specific time, day and location |
Created by:
bdavis53102
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