Pain Science

Question 1

3 types of pain
& another term for CS

Answer 1

nociceptive pain
neuropathic pain
nociplastic (central sensitization) pain

Question 2

what is nociplastic (central sensitization) pain in terms of tissue damage

Answer 2

no clear evidence of actual or threatened tissue damage

Question 3

what is the cartesian model of pain? What assumptions are made?

Answer 3

DAMAGE, INJURY, PAYCOLOGICAL

traditional model, pts still make assumtions from it like more pain=more damage, pain=injury, physical pain fuels psychological pain

Question 4

explain the modern day model of pain: name the 3 types of mechanisms

Answer 4

input, processing, output

Question 5

why is “pain” the wrong way to describe that A B and C fibers transmit? What is the correct word?

Answer 5

nociceptive, sending danger signals then the BRAIN turns the signals into pain

(brain makes pain decision NOT the fibers)

(bc is it just complete pain than all injuries would hurt despite the circumstances- ex: roll ankle alone vs bus ab to run you over)

Question 6

give an example of how culture/ growing up enviroment impacts how a person experiences pain

Answer 6

lots of exposure to pain early-> less chronic pain late

soft culture -> more pain

Question 7

more mechanical ion channels = ___ pain sensitivity (more/less)

Answer 7

more

Question 8

when are ion channels considered equal and resting?

Answer 8

homeostasis

Question 9

what is the great news about ion channels as they relate to pain

Answer 9

they can change! neuroplastic

Question 10

pain is an ____ of the brain
pain and injury are ___ synonymus
enviroment can ____/____impact the pain exeperience
changes in ion channel expression can lead to ___________ of the stimulus that opens that cannel

Answer 10

output
not
negitivly/ positivly
increased sensitization

Question 11

explain chronic pain in terms of interneurons inhibiting signals
What is this due to?

Answer 11

Question 12

Explain how 2nd order neurons contribute to chronic pain
Terms of G protein

Answer 12

replaced with receptors tha tincrease danger sign
G protien channels increase (“open gate”)

Question 13

explain the pain neurometrix

Answer 13

areas of the brain lti up by pain are diffrent for everyone

words, social media, etc. can influence this pain map

Question 14

Describe the hebbian theory

Answer 14

Question 15

use the lion example to explain how stress response is prolonged in chronic pain

Answer 15

Question 16

why is increased cortisol bad

Answer 16

it can cause multiple things to happen (muscle waste, bp, weight gain, inflammatory, etc)

Question 17

explain how chronic pain changes the hommunclulis

Answer 17

can change size of representation of a body part which then impacts:
- accurately identify any body part
-left right discrimination
-changes in the size of cortical maps

Question 18

what types of pts can benifit from PNE (pain neuroscience educstion)

Answer 18

-central sensitization
-chronic
-awaiting surgery

Question 19

explain how this shows signifigant evidence of PNE

Answer 19

Question 20

red vs yellow flags of pain in the screening process

If a red flag is systematic when should you order a referral?

Answer 20

red-patterns that suggest systemic orgin (weight loss, bowel bladder disfuntion, night pain, etc)
- immediate attention (further screening/ referral),

yellow- psychosocial barriers (fear, catastrophization, emotions)
- main contributor to pain and disability and have potential to increase risk of long-term disability and work loss

Question 21

self evaluation questionare: score to see __

Answer 21

anxiety
>39-40, older: >54-55

Question 22

PHQ-2 and PHQ-9: score to see __

Answer 22

depression
>2- evaluate further w phq9: >10

Question 23

tampa scale for kinesaphobia: score to see __

Answer 23

fear of mvmt
> 37

Question 24

pain catastrization scale score to see __

Answer 24

can only see worst possible outcome, unbearable situation when just uncomfy
> 30

Question 25

FABQw: score to see __

Answer 25

fear avoidence belief quesrionare work: >34/42

Question 26

FABQpa

Answer 26

fear avoidance belief questionnaire physical activity: >15/24

Question 27

Which test should each pt get out of the mental evaluation tests

Answer 27

depression one- PHQ-2

Question 28

Should you constantly be asking if pt is in pain during exercises

Answer 28

No, use the word pain sparingly `

Question 29

What 2 things need to be present to classify pain as central sensitization pain

Answer 29

disproportionate, hypersensitive/no logical nerve pathway of nerve 1. the perceived pain is disproportionate to the nature of the injury 2. hypersensitivity OR pain location doesn't follow logical nerve pathway

Question 30

What is the widespread pain matrix? What is the score u need to get?

Answer 30

used to acess widespread pain, score- >7

Question 31

What is the central sensitization inventory? score?

Answer 31

used to acess central sensitization (CS) or nociplastic pain >40

Question 32

What is the purpose of neurotesting someone with a sensitive nervous system (graphesthesia, 2 point, etc.)

Answer 32

sharpen homunculus map

Question 33

what is the accuracy goal (passing percent) of the neurotesting done on someone with a sensitive nervous system

Answer 33

at least 80% accuracy

Question 34

explain grid localization

Answer 34

its a neurotesting done on someone with a sensitive nervous system

Question 35

explain 2 point discrimination done on someone w a sensitive nervous system: how do you test?

Answer 35

start at 0mm, go up by 5mm, once oyu get 2 point number, go up from that number by 30mm, then secend by 5mm

Question 36

how do you test pain pressure threshold in neurotesting a sensitive nervous system?

Answer 36

Question 37

how do you test neurodynamic pain in neurotesting a sensitive nervous system?

Answer 37

put tension on nerve

Question 38

how do you test pain pressure threshold in neurotesting a sensitive nervous system?

Answer 38

palpate nerve

Question 39

how do you test Left Right discrimination in neurotesting a sensitive nervous system?

Answer 39

Question 40

How do you want to shift someones conception of pain while educating?

Answer 40

from a marker of tissue damage to a marker of the perceived need to protect body tissue

Question 41

How do you bill neuropain education

Answer 41

neuro re education

Question 42

Is it better to under or overdose exercise in the first apt

Answer 42

underdose

Question 43

what are the 4 princeiples for exercise perscription

Answer 43

expectation, baseline, pacing, education 1. provide expectation 2. establish a baseline (what can be completed w out cause symptoms) 3. discuss pacing 4. education (flare ups)

Question 44

what 4 things should always be included in PNE? pt neuroscience education?

Answer 44

sleep, education, goal, exercise sleep hygiene, pain education, goal setting, aerobic exercise

Question 45

How should an HEP be layed out for someone with chronic pain?

Answer 45

questions about education provided so they can reflect exercise aerobic exercise goals

Question 46

what are the 3 parts of a graded motor injury intervation

Answer 46

IN THIS SPECIFIC ORDER 1. left/ right discrimination 2. explicit motor imagery 3. mirror therapy

Question 47

goal of graded motor injury

Answer 47

cortical remapping (sharppen hommuculus map)

Question 48

explain explicit motor imagry

Answer 48

Question 49

explain mirror therapy and what precautions should be taken?

Answer 49

Question 50

compare a biomedial model of pain to a biopsychosocial model

Answer 50

biomedical - pathology causes symptoms, greater symptoms= more pathology, correction of pathology result in recovery biopsychosocial model -patient as a whole, not only biological factors but also psychosocial factors (thoughts, emotions)m and social factors (work) -provide patient with knowledge, understanding and skills to decrease pain and disability

Question 51

Yellow flags (as a concept)

Answer 51

cognitions like fear, anxiety and pain catastrophization that have a strong correlation to pain and disability