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Pain is a decision produced by the brain based on the perception of ____



What does fear avoidance lead to?

More pain and disability


What are the theories by Renee descartes in regards to pain that are wrong? What is their correct version?

- Nociception and pain are synonymous: Wrong, they are 2 different things
- Pain is an input driven system: Pain is an output by the brain
- Nervous system is a wire: It is alot more complicated than that, it is a living, breathing organism
- Assumption that there is a direct link between the amount of tissue damage and level of pain experienced
- All pain is caused by injury and increased pain means more damage
- Pain is either physical or psychological: Wrong, pain is an interwoven process
- In chronic pain, tissues are not healing and damage is ongoing


What drives the nervous system?

Emotions, thoughts, feelings


What is pain?

A multiple system output, activated by an individual's specific pain neural signature. The neural signature is activated whenever the brain perceives a threat


What is the mechanism of pain processing via body- self neuro-matrix?

- Sensory
- Cognitive
- Affective


What controls your ion channels?

The brain


What are the consequences of an unhealthy peripheral nervous system?

- Bombardment of C- fiber activity into the CNS dorsal horn resulting in permanent changes over time
- Retrograde firing of nerves resulting in increased inflammation, swelling and immune responses


Where does sensory information come through the spinal cord?

The dorsal horn


____ is a gating mechanism for information in the spinal cord



What is the difference between the second order wide dynamic ranging neuron and the second order nociceptive neuron?

The wide dynamic neurons can fire rapidly, while the nociceptive neurons need time


How can more info be passed from the spinal cord up to the brain?

Persistent firing via C fibers over a period of time will kill the interneurons, which are the gate keepers on the dorsal horn. This is the essence of central sensitization


What is one of the biggest predictors of chronic pain?

Acute pain


What sensation fires easier into the dorsal horn?

Light touch


What is the consequence of the death of the inhibitory neurons in the spinal cord/dorsal horn?

Decreased gating from the periphery


What is the consequence of when C-fibers pull back; A- fibers grow in in the spinal cord/dorsal horn?

Allodynia: light touch hurting


What is the consequence of the up-regulation of second order neurons in the spinal cord/dorsal horn?

Increased firing towards the brain


What is the consequence of inappropriate synapsing- other levels in the spinal cord/dorsal horn?

Spreading pain


What is the consequence of inappropriate synapsing- other fibers in the spinal cord/dorsal horn?

Sympathetic, immune, motor contributions


What is the consequence of inappropriate synapsing- other sidein the spinal cord/dorsal horn?

Bilateral "mirror" pains


What is the consequence of decreased endogenous mechanisms in the spinal cord/dorsal horn?

Allodynia and Hyperalgesia: increased sensitization/pain experience


What are the common areas in the brain frequently ignited during pain?

- Premotor/ motor cortex: organize and prepare movements
- Cingulate cortex: concentration, focus
- Prefrontal cortex: problem solving, memory
- Amygdala: fear, fear conditioning, addiction
- Sensory cortex: sensory discrimination
- Hypothalamus/thalamus: stress response, autonomic regulation, motivation
- Cerebellum: movement and cognition
- Hippocampus: memory, special recognition, fear conditioning
- Spinal cord: gating from the periphery


What happens in the brain when a person is in a potentially dangerous situation?

- How dangerous is this? --> This is dangerous/i need more info ---> Facilitation/neuronal adaptation

- How dangerous is this? ---> this is not dangerous ---> inhibition endogenous


What are the body's main distress chemicals?

- Adrenaline
- Cortisol


What does cortisol do to tissues?

Makes them:
- Sore
- Tired
- Sensitive
- Fatigued


What functions of the brain does cortisol affect?

- Memory
- Sleep
- Concentration
- Blood pressure
- Reproduction
- Other


How does cortisol affect the immune system?

- Increased nerve sensitivity
-Persistent inflammation
- Brain plasticity


What are the ways to calm the nerves when a person is in pain?

- Education
- Aerobic exercise
- Medicine
- Sleep
- Relaxation, meditation, therapy


What should the content of the treatment of central sensitization pain include?

• Pain neuroscience education
• Stress management
• Graded activity & exercise therapy, including desensitization by retraining pain memories


Why is pain neuroscience education so important?

It leads to the reconceptualization of pain, which leads to a reduced threat value of pain, which leads to less fear