Chronic Pian management

Question 1

how to safeguard against future failed efforts

Answer 1

• identify yellow flags
• maladaptive believes/expectations/behaviours
• presence of major life stressor
• look for signs of self efficacy

Question 2

what are maladaptive beliefs and pain behaviours

Answer 2

-reflexive behaviours that are not the result of intentional make

(continued avoidance of mvmt, disengagement, catastrophizing, fear avoidance, anticipation of pain)

Question 3

what in the most important determinant of disability

Answer 3

Self efficacy

Question 4

examples of classification systems in management (3)

Answer 4

1. stages of healing
2. Pain mechanisms
3. injury mechanisms

Question 5

features of inflammatory stage of healing

Answer 5

0-7d

• transient vasoconstriction leads to microvascular dilation
• pain w mvmt, evidence of gaurding
• night pain

Question 6

what to do w pt in inflammatory stage

Answer 6

• educate, reassure, protect

- unloaded movement with pain free available ranges of motion

Question 7

what to do w pt in proliferative phase

Answer 7

• unloaded movement, working towards full ROM within 4-6w

- Introduce controlled loading within pain free postures and jt pos.

Question 8

What to do w the patient in the repair and remodelling stage of healing

Answer 8

• Use dif loading stats to continually remodel connective tissue (end range loading, EC)
• time under tension to build endurance and challenge greater ROM in combo w multi jt movements (usually lack of loading when not progressing)

Question 9

what is nociceptive inflammatory pain

Answer 9

• typically localized, intermittent or consistent-described as swollen, full, throbbing
• earliest stages of tissue healing OR too much too soon in later stages, increased pain in morning/evening

Question 10

What is nociceptive ishemic and when does it happen

Answer 10

-occurs later in healing response (>12W)

• insufficient vascularization and oxidation of tissues
• worse as the day progresses or activity dependent

Question 11

neurogenic/neuropathic pain mechanisms

Answer 11

localized (receptor field)

-less predictable 24hr period, often worse at night

Question 12

what are affective pain mechanisms

Answer 12

Involves central pathways related to negative emotions, perceptions and behaviours

Question 13

What are central sensitization pain mechanisms

Answer 13

Altered cognition and interpretation of nociceptive signals occurring in the CNS

-persistence nociceptive input can induce CNS changes

Question 14

What are motor/autonomic pain mechanisms and Ex,

Answer 14

• facilitated inflammatory mechaniss, autonomic/vasomotor dysfunctions, neuroplastic/cortical changes
• widespread, non anatomical distribution w inconsistent 24hr behaviour

ex- CRPS

Question 15

What is derangement syndromes and how to TX

Answer 15

-disturbance of normal resting pos of jt surfaces,resulting in pain

• avoid mvmt direction that exacerbates pain and adress faulty mvmts patterns
• Utalize mvmt strats that abolish/reduce pain

Question 16

What are dysfunction syndromes and how to tx

Answer 16

-deformation of struccturally impaired msk tissues (end range/restricted mvmt)

• tissue deconditioning/fatigue almost always a factor
• mobailzing exercises in the direction of dysfunction or direction of reproduction of pain (restore ROM)

Question 17

Tissue fatigue syndrom and how to tx

Answer 17

• High volume of repativi physical stress to tissues over prolonged duration (slow + progressive onset)
• Reduce cumulative tissue load with active and passive strats, identify contributing environmental factors

Question 18

What is postural stress syndrome and how to tx

Answer 18

• pain arrives w static positioning and abates w moveemnt

- pt education on mechanism behind cumulative postural strain, pacing, general fitness/conditioning

Question 19

5w of massage for fibromyalgia did what

Answer 19

recuded anxiety/depression

Question 20

HVLA effects

Answer 20

• increase pain thresholds and decrease motor neuron excitability measured by the H reflex
• SMT can decrease mm spindle activity, reduce motor neuron excitability and reduce EMG

-not better than other tx tho

Question 21

how does nerve sliding initiate tension (3)

Answer 21

1. 1st 1/3 of mvmt takes up slack
2. 2nd 1/3 of mvmt is where sliding occurs
3. 3rd 1/3 of mvmt is where tension develops

Question 22

General pa guidlines

Answer 22

• No correct activity excists
• pt guided, shorter duration, low intensity
• adequate recovery periods
• can have discomfort day but not a flared day following

Question 23

psychological benefits of exercise

Answer 23

BDNF enhance the survival and differentiation of neurons and stim neurogenesis
-improves the quality of sleep, counteracts the mental decline w age, effectove at tx depression + anxiety

Question 24

running vs weight training for depression

Answer 24

both similar; no sig difference

Question 25

best exercise for OA

Answer 25

stregening/full body/aerobic probably best

Question 26

effectiveness of ex for fibromyalgia

Answer 26

sig benefits - most prefered arobic compared to strength - 8w of aerobic was superior - pool therapy was good too

Question 27

tx for acute/chronic LBP

Answer 27

acute- reassurence, adviem self care strats chronic- education, self management, stay active, sup exercise, multimodal rehab

Question 28

Exercise choses for chronic lowbackpain

Answer 28

exercise should mimic most vulnerable mvmts

Question 29

incomprlete vs complete tears strain %

Answer 29

incomplete start at >6% Complete occur at 8-10% -research suggests that tendinosis may be the result of chronic underloading and not overloading

Question 30

traffic light system for exercise prescription

Answer 30

Green- pain is no worse than baseline or pain improves and resolves after 6hr Yellow- pain persists but no worse than during activity, takes >6hrs to resolve Red- Pain worsens during exercise and it stops you from performing the activity any longer