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Pain Science Test 1 Flashcards

(67 cards)

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1
Q

T or F

The brain decides when you will be experiencing pain

A

True

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2
Q

T or F

Special nerves in your spinal cord convey “danger” messages to your brain

A

True

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3
Q

Pain mechanism

Input :Tissues

A

Mechanical
Thermal
Chemical

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4
Q

Pain Sensitization

A

Increased responsiveness of nociceptive neurons to their normal input,
And/or
Recruitment of a response to normally sub-threshold inputs

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5
Q

T or F

Pain only occurs when you are injured

A

False

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6
Q

Processing via body-self neuromatrix

A

Sensory
Cognitive
Affective

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7
Q

Persistent firing of ___ will kill ___ with ___.

This is essence of ___.

A

C-fibers Over time will kill interneurons (gate keepers)

High levels of amino acids kill the interneuron

This is the essence of central sensitization

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8
Q

Flags…

A

Red: serious pathology

Orange: psychiatric (depression, personality disorders..)

Black: healthcare system (insurance limitations, legislation..)

Blue: work-related factors

Yellow: pain behavior, emotional responses, beliefs/appraisals/judgements

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9
Q

Decreased endogenous mechanisms

Consequence

A

Allodynia and Hyperalgesia

Increased sensitization/pain experience

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10
Q

STarT Back Scores

A

<4 low risk; suitable for primary care mgmt

> =4 medium risk; suitable for PT?

Psychosocial subscale score >=4
High risk; requires combo of physical and cognitive behavioral approaches

Intake scores predict 6 mo disability scores (but not pain or impairment)

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11
Q

T or F

Nerves adapt by making ion channels (sensors) stay open longer

A

True

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12
Q

Chronic pain % in US adults
3 months of some type of specific pain….
Widespread pain…

A

43% population (Specific body area)

11% chronic widespread pain

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13
Q

T or F

Chronic pain means an injury hasn’t healed properly

A

False

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14
Q

Inappropriate synapsing- other fibers

Consequence

A

Sympathetic, immune, motor contributions

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15
Q

Hyperalgesia

A

Increased pain from a stimulus that normally provokes pain

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16
Q

Other (non-pain) sensory afferents are ___ fibers

A

Fast fibers

Usually A-Beta

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17
Q

Cortisol -Tissues

A

Sore
Tired
Sensitive
Fatigued

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18
Q

Inappropriate synapsing - other levels

Consequence

A

Spreading pain

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19
Q

T or F

The brain can send messages down your spinal cord that can increase the danger messages going up the spinal cord

A

True

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20
Q

Pain mechanism

Outputs

A

Pain
Action programs
Stress regulation

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21
Q

Peripheral pain

A

Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields

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22
Q

T or F

When you are injured, special receptors convey the danger message to your spinal cord

A

True

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23
Q

Definition of pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

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24
Q

Cortisol- immune

A

Cytokine signaling
Increased nerve sensitivity
Persistent inflammation
Brain plasticity

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25
Cortisol - brain
``` Memory Sleep Concentration Blood pressure Reproduction ```
26
T or F | When you are injured, chemicals in your tissue can make nerves more sensitive
True
27
T or F | Pain occurs whenever you are injured
False
28
T or F | Nerves can adapt by increasing their resting level of excitement
True
29
T or F | When you are injured, the environment that you are in will not have an effect on the amount of pain that you experience
False
30
Inappropriate synapsing- other side | Consequence
Bilateral “mirror” pains
31
FABQ | Cutoff
Fear avoidance beliefs questionnaire Screen for elevated fear-avoidance beliefs Cutoff scores: FABQ-PA >15 FABQ-W >29 (work related acute LBP) FABQ-W >22 (general ortho pt/no compensation)
32
T or F | In chronic pain, chemicals associated with stress can directly activate danger messenger nerves
True
33
T or F | When part of your body is injured, special pain receptors convey the pain message to your brain
False
34
Unhealthy PNS | Retrograde firing of nerves...
Increased inflammation, swelling and immune response
35
PHQ-9 scores
``` 0-4 no depression 5-9 mild depression 10-14 moderate depression 15-19 moderately severe depression 20-27 severe depression ``` Q10- any response besides “not difficult at all” is considered + for major depressive disorder and needs professional help
36
C-fibers pull back A-fibers grown in Consequence
Allodynia
37
T or F | The timing and intensity of pain matches the timing and number of signals in danger messages
False
38
Unregulation of 2nd-order neurons | Consequence
Increased firing towards brain
39
T or F | It is possible to have pain and not know about it
False
40
T or F | Worse injuries result in worse pain
False
41
CDC 2010- pain reported over 3 months
LBP 28% Knee 19.5% Neck 15%
42
Unhealthy PNS | Bombardment of C-fiber activity...
Into CNS dorsal horn resulting in permanent changes over time
43
T or F | Receptors on nerves work by opening ion channels (sensors) in the wall of the nerve
True
44
Depression screening: Probability of severe depression decreases from __ to ___ with 1 negative response And ___% of yes to both questions
20% to ~ 5% 50% chance if yes to both
45
CIPA: Congenital Insensitivity to Pain with Anhydrosis
Congenital disorder Don’t feel pain Frequent injuries/fractures Most die by 3 y/o Remaining don’t live to 25
46
FADQ
Fear of Daily Activities Questionnaire - identify fear of specific activities 10 movements/activities Rate fear of each one on VAS Average the first 10 items for FADQ score
47
Death of inhibitory neurons | Consequence
Decreased gating from the periphery
48
Weaknesses of Gate theory
1. Ignores psychological/mood 2. Over-simplified 3. Premise: neural system is hardwired (research shows plasticity)
49
T or F | Second-order messenger nerves post-synaptic membrane potential (excitement) is dependent on descending modulation
True
50
T or F | Descending neurons are always inhibitory
False
51
Typical pain neural signature
1. Premotor/Motor cortex 2. Cingulate cortex 3. Prefrontal cortex 4. Amygdala 5. Sensory cortex 6. Hypothalamus/Thalamus 7. Cerebellum 8. Hippocampus 9. Spinal cord
52
T or F | In chronic pain, chemicals associated with stress can directly activate danger messenger nerves
True
53
Multiple psychological factor screening
OMSQ Orebro MSK screening questionnaire 12 items Useful to identify work-injured patients at-risk of persistent MSK problems
54
PCS | Cut offs
Pain catastrophizing scale 11: 25th percentile 20: 50th percentile 31: 75th percentile > 50th (20) suspicion of psychological influence > 75th (31) consider (+) for psychological influence
55
T or F | The body tells the brain when it is in pain
False
56
T or F | Pain only occurs when you are injured or at risk of being injured
False
57
Allodynia
Pain due to a stimulus that does not normally provoke pain
58
Pain afferents are ___ fibers
Slow fibers | A-delta and C fibers
59
If patient is positive on the 2 question depression screen- consider..
Full questionnaire option PHQ-9 To assess diagnosis and severity of depression (Q9 relates to suicide ideation)
60
Cut-off scores for OMPQ
<57 0 paid days off work >72 28 days or more off work >72 Poor recovery >72 NRS (severity of pain) Score over 72, consider assessing specific factors
61
Central pain
Increased responsiveness of nociceptive neurons in the CNS to their normal or sub-threshold afferent input
62
TSK | Cut offs
Tampa Scale of Kinesiophobia Assess pain-related fear and fear of re-injury (17 items) 11: 25th percentile 22: 50th percentile 33: 75th percentile > 50th (22) suspicion of psychological influence > 75th (33) consider (+) for psychosocial influence
63
T or F | In chronic pain, chemicals associated with stress can directly activate danger messenger nerves
True
64
T or F | Nerves can adapt by making more ion channels (sensors)
True
65
STarT Back
Subgroups for Targeted Treatment Back Screening Tool Developed for back pain to assist GP referral to appropriate mgmt Psychosocial subscore
66
___ miles of nerves. Nerves need....
45 miles of nerves Nerves need: Space Movement Blood
67
Pain mechanisms | Input: Neuropathic
Ion channel expression

Pain Science (2 decks)

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