Pain and Healing

Question 1

what is pain?

Answer 1

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

Question 2

what are nociceptors?

Answer 2

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

Question 3

Peripheral sensitization

Answer 3

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

Question 4

central sensitization

Answer 4

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)

Question 5

What is released during the fight or flight response?

Answer 5

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

Question 6

What does the fight or flight response result in?

Answer 6

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

Question 7

How are pain receptor activated?

Answer 7

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

Question 8

What is the role of pain receptors?

Answer 8

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

Question 9

what are the 3 kinds of peripheral pathways

Answer 9

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

Question 10

What are A-delta fibers?

Answer 10

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

Question 11

what are C fibers?

Answer 11

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

Question 12

what are a-beta pathways?

Answer 12

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

Question 13

sympathetic nervous system influences on pain modulation and control:

Answer 13

fight or flight response

chronic sympathetic activations frequently exacerbate pain

Question 14

motor system influences on pain modulation and control:

Answer 14

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

Question 15

What is acute pain?

Answer 15

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

Question 16

What is chronic pain?

Answer 16

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

Question 17

What is nociceptive pain?

Answer 17

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

Question 18

what is neuropathic pain?

Answer 18

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

Question 19

what is dysfunctional pain?

Answer 19

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

Question 20

what is psychogenic pain?

Answer 20

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

Question 21

What are the goals of pain management care?

Answer 21

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

Question 22

what are some common pain management approaches?

Answer 22

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

Question 23

what are the three stages of healing?

Answer 23

acute, subacute, and maturation

Question 24

characteristics of the acute stage:

Answer 24

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

Question 25

What is primary edema?

Answer 25

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

Question 26

What is secondary edema?

Answer 26

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

Question 27

What is the last phase of the acute phase?

Answer 27

Hematoma formation

Question 28

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

Answer 28

Decrease secondary edema formation; decrease pain; initiate edema uptake

Question 29

characteristics of the subacute stage?

Answer 29

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

Question 30

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

Answer 30

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

Question 31

characteristics of the maturation stage:

Answer 31

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

Question 32

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

Answer 32

Prevent adhesions | facilities collagen remodeling

Question 33

What can cause chronic inflammation?

Answer 33

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

Question 34

What three factors affect the healing process?

Answer 34

Local external systematic

Question 35

What are some local factors that effect healing?

Answer 35

Type, size, and location of injury | Vascular supply

Question 36

What are some external factor that effect healing?

Answer 36

Therapeutic use of physical agents (modalities) | Movement

Question 37

What are some systemic factors that effect healing?

Answer 37

Age Disease Medications - with systemic effects Nutrition

Question 38

What are some of the most important determinants of healing?

Answer 38

Regenerative capacity of the tissue Vascular supply Extent of Damage

Question 39

Healing characteristics of cartilage

Answer 39

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

Question 40

healing characteristics of tendons and ligaments

Answer 40

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

Question 41

healing characteristics of skeletal muscle

Answer 41

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

Question 42

Healing properties of bone

Answer 42

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)