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Flashcards in Pain and Healing Deck (42)
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what is pain?

a warning of actual or potential tissue damage
an essential function for survival
a complex interaction between mechanical neurological, psychological, and sociological factors


what are nociceptors?

receptor of a sensory neuron that responds to potentially damaging stimuli
it sends signals to the spinal cord and brain


Peripheral sensitization

Is a lowering of the nociceptor firing threshold in response to the release of various substances for nociceptive afferent fibers
It causes an increased magnitude of response to stimuli and an increase in the area from which stimuli can evolve action potentials


central sensitization

process of central nervous system adaptation to nociceptive input that changes transmission from peripheral nerves to the CNS; increase in the magnitude and duration of the response to noxious stimuli (primary hyperalgesia); enlarges the receptor fields of the nerves (secondary hyperalgesia); normal non-noxious stimuli becoming painful (allodynia)


What is released during the fight or flight response?

Release of epinephrine, norepinephrine, endorphins and other hormones and neurotransmitters


What does the fight or flight response result in?

Increased attention, muscle tone, hearth rate, BP, and skin conductance


How are pain receptor activated?

by intense thermal, mechanical, or chemical stimuli (both internal and external)


What is the role of pain receptors?

to convert stimulus into electrical activity to form action potentials; the signal travel along afferent nerves toward the spinal cord and the brain


what are the 3 kinds of peripheral pathways

A-delta fibers (small and myelinated), C fibers (small and unmyelinated), A-beta fibers


What are A-delta fibers?

small and myelinated peripheral pathways that are the thickest and fastest fibers; respond to intense mechanical stimuli and heat or cold; are sensations that are sharp, stabbing, or prickling


what are C fibers?

small and unmyelinated peripheral pathways that are slow in onset, long lasting, diffusely localized, accompanied by sweating, increased heart rate and BP or nausea; the sensations are dull, throbbing, aching, burning, tingling, or tapping


what are a-beta pathways?

they are peripheral pathways the are non-painful sensations related to vibrations stretching, and mechanical pressure; they can be involved in abnormal, prolonged pain perception


sympathetic nervous system influences on pain modulation and control:

fight or flight response
chronic sympathetic activations frequently exacerbate pain


motor system influences on pain modulation and control:

muscles can become stiff in order to protect tissue from further pain or injury; pain can thus lead to impairment of movement and balance


What is acute pain?

The direct result of actual or potential tissue injury due to a wound, disease, or invasive procedure; expected to resolve w/in 3-6 month depending on pathology


What is chronic pain?

pain that is enduring or recurrent and persists longer than typical for a condition; there is an inadequate response to appropriate and/or invasive care; it can cause a significant impairment or functional status


What is nociceptive pain?

Pain that ha a clear stimulus-response relationship with the initial injury


what is neuropathic pain?

pain that is usually accompanied by signs or symptoms of neurological dysfunction, such as a paresthesia, itching anesthesia or weakness


what is dysfunctional pain?

pain that does not serve a protective function; it is persistent, spreading worsening, and unpredictable pain without a clear cause


what is psychogenic pain?

pain where psychological processes play a large role, including somatization and conversion disorders


What are the goals of pain management care?

resolving underlying pathology when possible; modifying discomfort and suffering; and maximizing function within the limitations imposed by patient's condition


what are some common pain management approaches?

physical agent (modalities), pharmacological approaches, exercise, cognitive behavioral therapy, and manual therapy


what are the three stages of healing?

acute, subacute, and maturation


characteristics of the acute stage:

inflammatory phase
associated with heat swelling, redness, pain, and los of function
Immune response: activates neutrophils and other infection fighting cells
hemostatic response: stops bleeding
begins at the time of tissue damage and lasts from several hours to 3/4 days
pain and muscle spasms as well as edema


What is primary edema?

The hemorrhaged fluid, cells, and chemicals form the damaged tissues (exudate); vasodilation is increased;


What is secondary edema?

High concentrations of proteins, in the area from the primary edema causes an increase in pressure in the area; Fluid is pulled out of previously undamaged cells and capillaries in an effort to dilute the large quantity of protein; Can cause reduced ROM or tissue flexibility


What is the last phase of the acute phase?

Hematoma formation


What are the goals of rehab during the acute phase of healing?

Decrease secondary edema formation; decrease pain; initiate edema uptake


characteristics of the subacute stage?

Begins around day 4 post trauma and continues up to six weeks
Reabsorption of leukocytes and phagocytes to circulation
Proliferation of granulation tissue (beginning of healing process)
Collagen remodeling (process of thickening and strengthening the granulation fibers)
swelling decreases
discoloration turns to purple/yellow
increased ROM
Pain with tissue resistance


What are the goals of rehab during the subacute phase of healing?

To continue to decrease edema and spasms; facilitates formation of flexible and well aligned repair fibers


characteristics of the maturation stage:

begins after the subacute stage and lasts from 3 months to one year
completion of the collagen remodeling stage
granulation tissue has been completely dissolved and recycled
80% ROM returned
no pain with resistance in the second half of this stage


What are the goals of rehab during the maturation phase of healing?

Prevent adhesions
facilities collagen remodeling


What can cause chronic inflammation?

persistence of injuring agent (cumulative trauma); interference of normal healing process


What three factors affect the healing process?



What are some local factors that effect healing?

Type, size, and location of injury
Vascular supply


What are some external factor that effect healing?

Therapeutic use of physical agents (modalities)


What are some systemic factors that effect healing?

Medications - with systemic effects


What are some of the most important determinants of healing?

Regenerative capacity of the tissue
Vascular supply
Extent of Damage


Healing characteristics of cartilage

Limited healing ability
Lacks lymphatics, blood vessels, and nerves
cartilaginous injuries that also involve subchondral bone allow inflammatory ells to gain access to repair nearby cartilage


healing characteristics of tendons and ligaments

The potential for repair of these tissues depends on the type of tendon or ligament, the extent of damage, vascular supply, and control of movement
If healing occurs tendons possess a unique scar maturation phase that can achieve an advanced state of repair
Unlike tendons, ligament heal better with controlled passive mobilizations


healing characteristics of skeletal muscle

Can be injured by trauma, strain, or muscle diseases
Healing an occur in some cases through stem cells that can proliferate and differentiate
After severe contusion, a calcified hematoma can develop


Healing properties of bone

4 stages of healing
- inflammation (shortly after impact)
- soft callus (after swelling subsides)
- hard callus (3 weeks to 4 months)
- bone remodeling (months to years)