Give examples of some Rehabilitation Techniques
“The restoration of normal form and function after injury or illness”
– Dorland’s Medical Dictionary 28th ed.
- Ergonomic training?
- Stretching/strengthening exercise?
- Psychological counseling?
Define and compare ACTIVE/PATIENT-CENTERED & PASSIVE CARE
Clinician as Healer, Patient as Recipient
- Physical modalities (EMS, ultrasound, laser)
Active Care or Patient-centered
Clinician as Coach, Patient as Active Participant
- Postural reeducation
- Motor control
How is pain Classified?
1. Short term pain (< 3 months)
2. Usually relates to tissue damage
3. Hurt usually = harm
4. Useful warning sign / protective
5. Biopsychosocial factors are important from the outset.
1. Persistent / longstanding
2. Usually not an indicator of ongoing tissue damage
3. Hurt usually does not = harm
4. No longer a useful warning sign
5. Biopsychosocial factors are very relevant
What are some key assumptions of the traditional model of pain?
- Pain is the result of tissue damage/injury
- Pain transmission is directly from the periphery to the brain
- The amount of pain is directly proportional to the extent of tissue damage/injury - we now know this is not the case "phantom limb pain"
What is the relationship between symptoms(pain) and pathology?
i.e LIMITATIONS OF TRADITIONAL PAIN MODEL
"an unpleasant sensory and emotional experience associated with actual or potential tissue damage."
- pain is a bad indicator of pathology -
- Pts can vary in pain from extreme to little pain with/without pathology
- pain is not directly proportional to pathology
- It is possible to have a very different outcome (e.g. pain and function) from the same treatment for the same problem.
What are some POOR & GOOD predictions of disability?
(Pincus & McCracken, Best Prac Res Clin Rheum, 2013)
Poor predictors of disability:
- X-Rays and MRI scans
- History of trauma
- Type of work
- Back function/screening tools
Good predictors of disability:
- The “psychosocial” factors…
- Physical deconditioning
- Mental health
What is the CURRENT understanding of CHRONIC PAIN?
Chronic pain is not ‘All in the mind’, made up, psychosomatic or psychological and patients are not malingering and do not have psychological overlay
- Pain is a perceptual process
- Pain is always (even in the acute stage) a combination of biological, psychological and social factors – the biopsychosocial framework
- We need to be mindful of these factors and we need to be able to assess and address them.
Describe the Freudian Approach to pain PSYCHOANALYTIC THINKING
- (Id, Ego, Superego)
conscious or unconscious guilt with pain serving as a form of atonement, or the development of pain to replace feelings of loss
- BY MAKING THE UNCONSIOUS CONSCIOUS Pts can deal with unresolved gilt/desires to relieve pain
Describe the BEHAVIORIST MODEL in the context of pain
- Pavlov and his dogs
- rewards given to promote/distinguish behaviors
- no consideration given to emotion
Describe COGNITIVE BEHAVIOR THERAPY (CBT) and give examples of interventions used in this model
Activating Event: social event invitation - public speech
Thoughts: "people think i'm stupid"
i will enjoy socialising with friends
Behaviour: worry, think about what to say
Look foreard to the event
Physical reaction: sweating, heart racing, rapid breathing
Calm breathing, relaxed body language
acts as cycle 1-4 or can occur non sequencially