DEVELOPING CRITICALITY

Question 1

Define pain

Answer 1

“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. (IASP, 2020)

Question 2

What is the nociceptive pain mechanism?

Answer 2

Pain in a specific part of the body related to movement.

Pathological process in peripheral organs and tissues. Pain projection into damaged body part or referred pain. Pain in a localised part of the body which is related to movement, usually a dull ache.
Nocioceptors can be stimulated by thermal, mechanical and chemical factors
Pain arising from the activation of the nociceptors is called nociceptive pain. Nociceptive pain can be classified according to the tissue in which the nociceptor activation occurred: superficial somatic (e.g. skin), deep somatic (e.g. ligaments/tendons/bones/muscles) or visceral (e.g. internal organs).

Question 3

What is the neuropathic pain mechanism?

Answer 3

Pain which is burning, shooting, sharp, or like an electric shock.
Pain caused by lesions or disease of the somatosensory nervous system. Nerve pain, a more severe shooting pain. Indictaes potential nerve damage.

Question 4

What is the nocioplastic pain mechanism?

Answer 4

Pain that arises from altered nociception despite no clear evidence of actual tissue damage. Activation of peripheral nociceptors or evidence for disease of the somatosensory system. Wider spread pain with no evidence for tissue damage eg fibromyalgia.

Question 5

What is the central sensitisation pain mechanism?

Answer 5

An increased responsiveness of nocioceptors in the central nervous system to either normal or sub threshold afferent input resulting in HYPERSENSITIVITY to stimuli. Associated with wide spread pain.

Question 6

Define ontology

Answer 6

Concerned with the fundamental nature of the world

Question 7

Define epistemology

Answer 7

the theory of knowledge, especially with regards to its methods, validity and scope, and the distinction between justified belief and opinion.

Question 8

What does science set out to do?

Answer 8

To falsify claims. To disprove enough evidence. Going against the null hypothesis.

Question 9

Define methodology?

Answer 9

The framework or strategy to do the work

Question 10

Define research

Answer 10

The systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions.

Question 11

What is evidence based healthcare based on?

Answer 11

Best of research
Patient values
Clinical expertise

Question 12

What are the levels of research evidence?

Answer 12

1a - systematic reviews of randomised controlled testing
1b - individual randomised controlled tests
1c- all or nothing trials
2a - SRs of cohort studies
2c - outcome studies, ecological studies
3a - SRs of case control studies
3b - individual case control studies
4 - case series
5 - expert opinion

Question 13

What research leads to a non-causal claim?

Answer 13

Cohort studies
Case-control studies
case series
case reports
opinion

Question 14

What research leads to a causal claim?

Answer 14

Systematic review of randomised control testing with or without meta-analysis
RCTs
(comparative studies)

Question 15

Define regression to the mean?

Answer 15

The natural phenomenon whereby an individual’s pain gets better and worse naturally, with or without treatment.

Question 16

What methods have causal claims?

Answer 16

CBT
Hydrotherapy
Manipulation
Exercise

Question 17

What is allodynia?

Answer 17

Painful response to a normally non-painful stimuli

Question 18

What is hyperalgesia?

Answer 18

Exaggerated painful response to a normally mildly painful stimuli.

Question 19

What is TSP?

Answer 19

A progressive increase in pain perception in the response to repeated stimuli of the same intensity (temporal summation) eg someone performing knee exercises may complain of increasing levels of pain the more repitions of the same exercise they perform, which can be attributed to TSP.

Question 20

What is the Keele STarT Back tool?

Answer 20

A questionnaire consisting of yes and no questions, which help categorise a patient into High, Medium and Low risk
High - additional pshychological obstacles to recovery: enhanced package of care, BPS approach
Medium - mainly physical obstacles to recovery: good quality physio treatment
Low - low risk of chronicity: advice, reassurance, medication

Question 21

What are the four ethical principles?

Answer 21

Autonomy
Beneficence
Nonmaleficence
Justice

Question 22

What is base rate fallacy?

Answer 22

Where people tend to ignore the base rate
eg there are more sales people than librarians example

Question 23

What is the SPIN acronym?

Answer 23

Specific
Positive test
Rules the condition in

eg if positive ottawa ankle test, rules the condition in but at a low rate of probability as this test has a low specificity.

Question 24

What is the SNOUT acronym?

Answer 24

Sensitivity
Negative
Rules of condition out

eg if negative ottawa ankle test (as high sensitivity) can assume that an ankle fracture probably is not present.

Question 25

What is a randomised control trial?

Answer 25

Test whether an intervention works by comparing it to a control condition, either no intervention (placebo), or an alternative intervention (treatment as usual).