Modalities Ch. 8

Question 1

what is pain?

Answer 1

subjective
#1 reason an athlete seeks tx
physiological
modulates response to a pain inducing stimulus

Question 2

types of subjective pain

Answer 2

emotional
psychological
social

Question 3

why is pain physiological

Answer 3

it is associated w/ tissue damage

Question 4

cause and effect types of pain

Answer 4

simple pain
response aimed at protecting and healing
simple pain can become chronic pain (> 3 months)

Question 5

simple pain

Answer 5

acute pain
tissue damage
most sports-related pain
alarm system alerts brain to actual or potential tissue damage

Question 6

how does pain protect and heal the body?

Answer 6

it signals the brain that there is something wrong

plays a role in initiating the healing processes

Question 7

how can simple pain become chronic?

-% of pop. that suffers from chronic pain

Answer 7

untreated
incorrect treatment
20% suffer

Question 8

consequences of chronic pain

Answer 8

depression
decreased activity/disability
atrophy
loss of skill
anxiety
circulatory deficiency

Question 9

how is pain described?

Answer 9

subjectively
-burning, sharp, achey, deep
we try to make it objective
-1-10 pain scales

Question 10

nociception

Answer 10

ability to feel pain

Question 11

nociceptors

Answer 11

specialized nerve endings that respond to stimulus - mechanoreceptors, thermoreceptors, chemoreceptors

Question 12

how are nociceptors classified

Answer 12

by location

• cutaneous
• somatic
• visceral

Question 13

which nociceptors are most common?

Answer 13

mechanical nococeptors (a-delta, force)
polymodal nociceptors (C, heat, mechanical pressure)

Question 14

function of A-delta fibers

Answer 14

pain transmission
crude touch
pressure
temperature

Question 15

function of C-fibers

Answer 15

pain
touch
pressure
temperature

Question 16

nociception vs. pain

Answer 16

nociception
-specific neurophysiological activity
pain
-interpretation of nociception
--subjective and emotional

Question 17

impacts on pain

Answer 17

past pain experience
general life stress
heredity
personality differences

Question 18

common noxious stimuli

Answer 18

mechanical - pressure directly on a nerve (swelling, muscle spasm)
thermal
electrical
chemical - mediators that are present when injured, bradykinin

Question 19

pathway of pain

Answer 19

slam hand in car door
pain signal - chemicals released
chemicals signal receptor to generate a signal
signal travels up the arm on first-order neurons
transmit to the dorsal horn of the spinal cord
signals relayed to a second order neuron
neurons transmit the signal up the spinal cord
received at the thalamus
pain signal transmitted to the cerebral cortex by the third order neuron
pain signal is processed

Question 20

pain terminology

Answer 20

perception threshold
-when it starts to hurt
tolerance threshold
-when someone acts on the pain

Question 21

Specific Theory of Pain

Answer 21

specific nociceptors
specific nerve pathways
specific sensation

Question 22

Pattern Theory of Pain

Answer 22

no existence of specific pain receptors
slow-conducting nerve fibers carry pain
fast-acting nerve fibers carry other sensations
normally, the fast-conduction fibers override the pain
under pathological conditions, the intensity of the stimulation in the slow system becomes much greater and dominates the fast system, resulting in pain

Question 23

Pattern Theory of Pain flaw

Answer 23

too general - doesn’t account for receptor specialization

Question 24

Gate Control Theory

Answer 24

specificity + pattern theory
operates at spinal level
proposes a gate mechanism
central control

Question 25

gate mechanism

Answer 25

-pain and other sensory stimuli travel along both large and small nerve fibers -both stimulate T-cells which pass onto brain action system includes all responses to the pain inhibitory mechanism located in the substantia gelatinosa SG inhibits the T-cell differential stimulation of SG cells

Question 26

what types of pain do the large and small fibers carry?

Answer 26

large: sharp, stinging small: dull, aching

Question 27

how do large and small fibers stimulate the SG?

Answer 27

large: facilitates SG small: inhibits SG

Question 28

Gate Control Theory problems

Answer 28

does not account for phantom limb pain | cannot explain influence of drugs on pain

Question 29

types of pain relieving drugs

Answer 29

``` morphine naloxone enkephalin endorphin serotonin ```

Question 30

morphine function

Answer 30

blocks pain - fills neurotransmitter sites - neorutransmitter blocked

Question 31

naloxene function

Answer 31

morphine antidote: reverses effects

Question 32

enkephalin

Answer 32

- mixture of two peptides - similar in shape and similar analgesic properties as morphine - found in brain, spinal cord, gut - half-life very short thus operates at spinal cord level - block the gate by interfering w/ A-delta and C fiber signal transmission to T-cells - released through non-painful sensory stimulus - -sensory TENS, gentle massage

Question 33

endorphin - similar to... - where is it produced? - half-life - where does it act? - how does it work? - how are they released?

Answer 33

endogenous molecule similar to morphine produced in pituitary and circulated through body half-life = four hours acts in several areas of CNS (including dorsal horn) inhibits pain signal transmissions and decreases chemical irritants in CNS may be released by acupuncture and intense exercise

Question 34

serotonin

Answer 34

biochemical messenger and regulator found primarily in CNS, GI tract, and blood platelets mediates several physiological function, including neurotransmission may influence pain perception via descending tract (brain to spinal cord), block signals from peripheral nociceptors

Question 35

dopamine

Answer 35

neurotransmitter in extrapyramidal system of brain important in regulating movement may also be used to synthesize norepinephrine and epinephrin affects brain processes ___________

Question 36

opoids

Answer 36

endogenous opiates term used to denote body's internal pain killers such as enkephalin, endorphin, serotonin, and dopamine bind to opiate receptors in the brain operate in different parts of nervous system effective for varying lengths of time

Question 37

levels of pain control

Answer 37

level I: ascending influence pain control level II: descending influence pain control level III: beta-endorphin-mediated pain

Question 38

level I: ascending influence pain control

Answer 38

traditional gate control pain relief theory gating mechanism induce pain relief TENS, massage, cryotherapy

Question 39

level II: descending influence pain control

Answer 39

pain relief occurs in higher brain centers release of enkephalin modulates pain possible explanation for C-fiber activation relieving pain ex.: acupuncture or noxious TENS

Question 40

level III: beta-endorphin-mediated pain

Answer 40

prolonged stimulation of A-delta fibers triggers the release of beta endorphins longer term pain relief due to the 4hr half-life of endorphins

Question 41

dimension of pain

Answer 41

``` social emotional psychological physiological therapy is an art ```

Question 42

function of social, emotional, and psychological dimensions of pain

Answer 42

reasons why therapy doesn't work | affect the rate of therapy

Question 43

how to make a patient the owner of their pain

Answer 43

``` communication distraction education use it as a positive responsibility -pain meds. -treatment ```

Question 44

when do we ignore pain

Answer 44

``` minimal chronic sore vs. pain denial inconvenient/annoying conditioning ```

Question 45

when do we listen to pain

Answer 45

``` when it is significant interferes with everyday life visceral familiar -past experience ```

Question 46

what does it mean to respect pain

Answer 46

``` understand when it needs attention knowing when to stop/continue -past experience -type of pain -understanding consequences ```

Question 47

Dehne's Spinal Adaptation Syndorme

Answer 47

afferent nociceptive impulses from traumatized tissue alter the integration of central nervous excitation at the spinal cord -decreased response to volitional stimuli -increased response to otherwise subliminal peripheral stresses results in involuntary muscle action alters repair responds adversely to addition stress, favorably to reestablishing central control nociceptive impulses from traumatized tissue inhibit motor function and tissue repair voluntary activity can reestablish CNS control and prevent this inhibition prolonged inactivity after injury will lead to neural inhibition that may become permanent

Question 48

resetting central control

Answer 48

not enough to just get rid of the pain sensation must also get rid of the effects of the pain -reset the system

Question 49

Chicago Plane Analogy

Answer 49

a tire blowout occurs during takeoff the runway is shut down so the damaged plane and debris can be romoved the runway reopens (pain removed) however, thousands of passengers are stranded because of canceled flights (Chicago and elsewhere) meetings must be rescheduled, which takes time after the reopening of the airport

Question 50

resetting central control after injury

Answer 50

progression exercise

Question 51

source of athletic injury pain

Answer 51

``` nociceptor pain -cause of most sports injury pain relay impulse to spinal cord nociceptor is stimulated by -injured tissue (mediator release) -edema pressure -stretching injured tissue -otherwise normal activity in a tissue that is sensitized from disuse after injury ```

Question 52

source of athletic injury pain

Answer 52

neuropathic pain -complex, chronic pain state accompanied by tissue damage to nerve fibers occurs due to -acute nerve damage -disuse following injury -surgery that involves neural tissue -condition that cause nerves to become dysfunctional

Question 53

sources of athletic injury pain

Answer 53

``` learned pain -learned, or conditioned, response --"pain memories" -_________________ idiopathic pain -unknown origin --no identifiable pathology ```

Question 54

placebo - latin - ___% receive relief

Answer 54

``` latin-I shall please mock intervention patient belief psychological effects 35% of postoperative, diabetes, or chronic headache patients receive relief from placebos ```

Question 55

placebos | -why?

Answer 55

``` power of the mind believing something will work may increase effects -educate patients -be positive -set goals ```

Question 56

pain relief types

Answer 56

direct | indirect

Question 57

direct

Answer 57

get rid of the pain source

Question 58

indirect

Answer 58

treating the pain but not the source

Question 59

tools for relieving pain

Answer 59

``` immobilization therapeutic exercise counter-irritants thermotherapy electrotherapy cryotherapy psychological tools ```