Pain Lecture

Question 1

Nociception

Answer 1

Stimulation of peripheral pain nerve endings, transmit signal to CNS

Question 2

Pain

Answer 2

Unpleasant sensory/emotional experience associated w actual/potential tissue damage

Question 3

Suffering

Answer 3

Subjective evaluation on pain experience

Feeling associated w/anticipation of/actual threat to wellbeing

Question 4

Pain behavior

Answer 4

Observable actions in response to pain/suffering

Question 5

Acute Pain

Answer 5

• signal for real/impending tissue damage
• biological dysfunction
• concurrent w/ tissue damage or stress
• disappears w/healing

Question 6

Chronic/Persistent pain

Answer 6

• pain persisting after healing is complete
• 3 months (arbitrary)
• process, not an entity (they need to accept and live w pain)
• emotional pain, physiological factors, behavioral factors

Question 7

Chronic pain consists of

Answer 7

Autonomic dysfunction, CNS dysfunction, metabolic changes in painful tissue, motor control dysfunction, self, psychosocial

Question 8

OLDCARTS

Answer 8

Onset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Temporal
Severity

Question 9

Onset of pain

Answer 9

• sudden or gradual/insidious
• mechanics of injury if trauma
• first time? Reoccurrence?

Question 10

Location

Answer 10

• where
• has it spread or focused?
• does it change with activity?
• does it change w body positions?

Question 11

Duration

Answer 11

How long does it last?

Question 12

Characteristics

Answer 12

How severe is it? Is it sharp/dull/throbbing?

Question 13

Behavior (A/R)

Answer 13

Aggravating: what increasing pain– red flag if doesn’t change
Relieving- what makes it better

Question 14

Temporal

Answer 14

When does the pain occur?

Question 15

Severity rating

Answer 15

Number ranking, adjectives

Question 16

Interview questions for pain

Answer 16

• past treatments, meds, HCP
• describe original pain/onset mechanisms
• stress factors
• perception of cause of continued pain
• how will you know when you’re better?

Goals should be functionally oriented, not dependent on pain cessation!

Question 17

Body diagrams for pain

Answer 17

• specific anatomical location
• referred pain
• trigger points
• myofascial pain

Question 18

Physical exam for pain

Answer 18

Movement patterns
Neuro exam
AROM
Muscle strength
Posture

Question 19

Cyriax concept– active movement

Answer 19

• specific soft tissue can’t be incriminated

- provides info on mvmnt ability, painful range, possible originating pain location

Question 20

Cyriax concept– passive movement

Answer 20

• inert structures like capsule, ligaments, bursa, fascia

- gross assessment on length of soft tissue

Question 21

If both passive and active movement restricted in same direction

Answer 21

Indicative of capsular/arthrogenic lesion

Question 22

If active an passive actions are restricted/painful in opposite directions

Answer 22

Contractile lesion

Question 23

Resisted isometric testing– do where and what is contraindication?

Answer 23

• isolate contractile tissue in midrange

- ci = fracture close to muscle insertion or inflamed muscle

Question 24

Isometric testing– strong and painless

Answer 24

WNL/referred pain

Question 25

Strong and painful

Answer 25

Minor lesion of muscle/tendon

Question 26

Weak and painless

Answer 26

- disorder of nervous system - total rupture of myotendinous unit - disuse atrophy

Question 27

Weak and painful

Answer 27

- major lesion-- fx, neoplasm - acute inflammation - partial rupture of myotendinous unit

Question 28

Pain pattern- painful arc

Answer 28

- tender structure between two bony surfaces | - Subacromial bursa: 60 to 120 degrees shoulder abduction

Question 29

Pain pattern- pain w/ repetition of movements

Answer 29

Intermittent claudication

Question 30

Where is capsule laxest for.. | Hip? Knee? Ankle?

Answer 30

``` Hip = 30 degrees of flexion Knee = 30-45 degrees of flexion Ankle = 15 degrees of plantarflexion ```

Question 31

Central pain-- thalmic pain

Answer 31

Continuous aching/burning | Lesion in thalamus, maybe post-stroke

Question 32

Complex regional pain syndromes

Answer 32

Reflex sympathetic dystrophy | Causalgia

Question 33

RSD

Answer 33

Reflex Sympathetic Dystrophy: - early stage: pain w slight increase in skin temp, localized edema, muscle spasm - dystrophic stage: pain w lowered skin temp, hyperhidrosis, muscle atrophy -so it goes from increased temp and swelling and spasm to cold skin excessive sweating and muscle atrophy

Question 34

Causalgia

Answer 34

Burning sensation after partial peripheral nerve injury, trophies changes such as loss of sweat glands/hair, thinning skin

Question 35

Wadell's test

Answer 35

Tenderness, simulation, distraction, regional disturbances, overreaction

Question 36

What does Waddell test test for

Answer 36

-screening for nonorganic, psychological and social elements to pain syndrome-- apparently doesn't signify malingering but that's kinda bullshit

Question 37

What score do you look for to determine symptom magnification/possible illness behavior?

Answer 37

Greater than 3

Question 38

What is type II of Waddell test

Answer 38

SIMULATION: | Axial loading/rotation

Question 39

What is type IV of Waddell test?

Answer 39

REGIONAL DISTURBANCES | Weakness, sensory

Question 40

What is type V for Waddell

Answer 40

Overreaction

Question 41

What is type I of Waddell

Answer 41

TENDERNESS | -superficial, non-an atomic

Question 42

What is type III of Waddel's test?

Answer 42

DISTRACTION | SLR