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7 Orthopedics > L1 Intro to Pain > Flashcards

L1 Intro to Pain Flashcards

1
Q

US healthcare costs in 2016 for LBP

A

134 billion

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2
Q

What is the number one reason someone gets an opioid prescription?

A

low back pain

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3
Q

myths of LBP

A

awareness increasing means situation has improved

persistent LBP is indicative of serious problem and requires imaging

lumbar spine is so unique that it must be treated uniquely

it will get better on its own

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4
Q

What percentage of people will experience a significant episode of LBP in their lifetime?

A

80%

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5
Q

Regardless of intervention ____ will get better within ______.

A

80%
6-12 weeks

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6
Q

PT’s jobs for LBP

A

identify pts that won’t get better
help people get better faster
prevent people from getting worse
reduce the likelihood of another episode

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7
Q

What has been shown to help LBP?

A

education
activity modification
exercise
manual therapy
postural re-ed
ownership
self-efficacy
sleep
modalities

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8
Q

Framework for MSK patient exam and management

A
  1. Pain Behavior
  2. Pain Phenotype
  3. Impairment classification
  4. Plan
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9
Q

SINSS Model (Pain Behavior)

A
  1. Severity
  2. Irritability
  3. Nature
  4. Stage
  5. Stability
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10
Q

The SINSS model helps to…

A
  1. Create a framework for subjective history
  2. determine appropriate type and level exam
  3. prioritize patient’s problem list
  4. synthesize information after exam
  5. modify treatment plan including intervention scope, intensity
  6. create prognosis and need for referral
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11
Q

Severity

A

can be influenced by illness perceptions, psychological distress, and pain catastrophizing

negatively impacts prognosis

impacts ADLs and functional abilities

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12
Q

How to assess severity and irritability

A

VAS
pain behavior
START back screening tool

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13
Q

Irritability

A

impacts prognosis
recommend only AROM for exam initially
may need to adjust activities initially
tailor treatment to level of irritability

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14
Q

Patient with high severity and low irritability

A

OK to go into passive end ranges during exam

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15
Q

Nature

A

overall presentation, status of patient
biopsychosocial
medical/pathoanatomic diagnosis

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16
Q

Stage

A

inflammatory, proliferation, maturation OR known as acute, subacute, chronic

includes protection, level tissues can be stressed, and whether or resistance causes pain

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17
Q

Stability

A

worsening, improving, unchanging

worsening conditions may not provide immediate feedback of response to intervention

improving conditions may get better no matter what you do

unchanging conditions can be frustrating for providers and patients

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18
Q

Nociceptive pain

A

pain elicited by the injury of body tissues and activation of nociceptive transducers at the site of local tissue damage

commonly acute traumatic injury and inflammatory mediators

thermal, mechanical, chemical

19
Q

Neuropathic pain

A

pain caused by a lesion or disease of the somatosensory system

can be caused by maladapative structural changes, cell-cell interactions, molecular signaling

described as burning, pricking, squeezing

examples include trigeminal neuralgia, polyneuropathy, postherpetic neuralgia

20
Q

Nociplastic pain

A

persistent pain that arises from altered nociception, despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors, or evidence for disease or lesion of somatosensory system causing the pain

21
Q

What type of pain originates primarily from the peripheral tissues?

A

nociceptive

22
Q

What type of pain originates primarily from the feedback loop in the cortex?

A

nociplastic

23
Q

pain is not…

A

directly related to tissue damage
a direct linear link
equivalent to nociception and damage

24
Q

low back conditions that were found to not exhibit pain

A

disc degeneration
disc bulge
disc height loss
facet joint degeneration
disc protrusion

25
Q

Pain is…

A

adaptive
signal to change behavior
survival mechanism
construct
descriptive
contextual
individual experience
hierarchical

26
Q

Pain is hierarchical

A

difficult to feel more than one pain at once

allows us to filter

descending inhibitory pathways can close feedback loop

27
Q

Cognitive Function and Chronic Pain

A

Causes elevated levels of cortisol, prefrontal cortex activation is smaller, decision making and problem solving is impaired

pain becomes consuming and distracting

pain also interferes with sleep and exercise, which also influences cognitive function

28
Q

The practitioner that a pt sees first for LBP…

A

influences how much health care they use over the next year

those who choose PT have lowest healthcare use

29
Q

Pain should be targeted first through the CNS by

A

cognitive, emotional, and motor aspects

you need to find out what they know first, listen, provide digestible bites, use stories.

Ultimate goal is to help change how patients make sense of pain, build confidence, and optimize function

30
Q

Points from Moseley Pain Video

A
  1. Pain is always real
  2. Pain relies on context and clues
  3. Anything that suggests you need protecting takes pain up and anything that suggest you don’t, takes pain down
  4. Pain and tissue state are poorly related
  5. Humans are adaptable and bioplastic learners
  6. Movement is king
  7. Understand and retrain the pain system
31
Q

Cognitive Behavioral Therapy

A

involves the efforts to change thinking patterns and behavioral patterns

thinking = recognizing distorsions
Behavior = facing fears vs avoid

32
Q

LBP and exercise

A

get patients to do anything, as long as they are moving will help them

exercise are more effective than no intervention

will help to modulate pain and improve QOL

33
Q

PT combied with psychological interventions

A

caused decreased pain in short and long term, and decreased disability in short term

34
Q

Increased PT causes decreased

A

opioid usage
less costs over coming year

35
Q

Most LBP patients..

A

will improve over time regardless of treatment

clinicians should select nonpharrmacologic treatment first like yoga, motor control exercise, biofeedback, etc

36
Q

Should use for LBP

A

exercise, manual therapies (thrust first, then massage), patient education (neuroscience and active education)

37
Q

IF patient has high disability with volatile S/S

A

directional preference exercises
manipulation
traction
active rest

38
Q

If patient has moderate disability

A

sensorimotor exercises, stabilization exercise, flexibility exercises

39
Q

If patient has low disability

A

strength and conditioning exercises, work or sport tasks, aerobic, general fitness exercises

40
Q

If patient is irritable and inflamed

A

address the inflammation by active rest

41
Q

If patient peripheralize with extension and flexion or has positive SLR test

A

prescribe traction

42
Q

Patient centralizes with flexion or extension

A

prescribe specific exercises that centralize the symptoms

43
Q

Does the patient stop to centralize and have no symtpoms distal to knee?

A

prescribe manipulation

7 Orthopedics (11 decks)

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