Nociception
Stimulation of peripheral pain nerve endings, transmit signal to CNS
Pain
Unpleasant sensory/emotional experience associated w actual/potential tissue damage
Suffering
Subjective evaluation on pain experience
Feeling associated w/anticipation of/actual threat to wellbeing
Pain behavior
Observable actions in response to pain/suffering
Acute Pain
- signal for real/impending tissue damage
- biological dysfunction
- concurrent w/ tissue damage or stress
- disappears w/healing
Chronic/Persistent pain
- pain persisting after healing is complete
- 3 months (arbitrary)
- process, not an entity (they need to accept and live w pain)
- emotional pain, physiological factors, behavioral factors
Chronic pain consists of
Autonomic dysfunction, CNS dysfunction, metabolic changes in painful tissue, motor control dysfunction, self, psychosocial
OLDCARTS
Onset Location Duration Characteristics Aggravating factors Relieving factors Temporal Severity
Onset of pain
- sudden or gradual/insidious
- mechanics of injury if trauma
- first time? Reoccurrence?
Location
- where
- has it spread or focused?
- does it change with activity?
- does it change w body positions?
Duration
How long does it last?
Characteristics
How severe is it? Is it sharp/dull/throbbing?
Behavior (A/R)
Aggravating: what increasing pain– red flag if doesn’t change
Relieving- what makes it better
Temporal
When does the pain occur?
Severity rating
Number ranking, adjectives
Interview questions for pain
- past treatments, meds, HCP
- describe original pain/onset mechanisms
- stress factors
- perception of cause of continued pain
- how will you know when you’re better?
Goals should be functionally oriented, not dependent on pain cessation!
Body diagrams for pain
- specific anatomical location
- referred pain
- trigger points
- myofascial pain
Physical exam for pain
Movement patterns Neuro exam AROM Muscle strength Posture
Cyriax concept– active movement
- specific soft tissue can’t be incriminated
- provides info on mvmnt ability, painful range, possible originating pain location
Cyriax concept– passive movement
- inert structures like capsule, ligaments, bursa, fascia
- gross assessment on length of soft tissue
If both passive and active movement restricted in same direction
Indicative of capsular/arthrogenic lesion
If active an passive actions are restricted/painful in opposite directions
Contractile lesion
Resisted isometric testing– do where and what is contraindication?
- isolate contractile tissue in midrange
- ci = fracture close to muscle insertion or inflamed muscle
Isometric testing– strong and painless
WNL/referred pain
