23/04/2021
WHAT IS CHRONIC PAIN
⭐PAIN
♥️An unpleasant sensory and emotional experience associated with actual or potential tissue damage or psychological origin
⭐ACUTE PAIN
♥️Associated with tissue damage and resolves as the tissue heals. Usually associated with physiological signs of distress. Sweating, pallor, nausea, increased heart rate. Pain is proportional to tissue damage. Resolved when nociceptive causes are addressed.
⭐RECURRENT PAIN
♥️Repeated episodes of acute pain. Repeated episodes of low back strain, migraine headaches
⭐CHRONIC PAIN
♥️Pain that persists past the healing phase following an injury; impairment is greater than anticipated based on the physical findings or injury and occurs in the absence of observed tissue injury.
⭐TRIGGERING MECHANISM CLASSIFICATION OF PAIN
♥️Nociceptive
♥️Peripheral neuropathic
♥️Central sensitization
⭐NOCICEPTIVE PAIN
♥️Pain that is localized to an area of injury or dysfunction.
♥️Pain is aggravated or eased with movement or positions
♥️Clear mechanical trigger
⭐A- DELTA FIBERS
♥️Transmit detailed somatosensory information
♥️5-10 times slower than other sensory receptors for touch, pressure, proprioception, muscle spindles, and Golgi tendon organs.
♥️Generally innervate cutaneous structures
♥️Generally produce sharp, localized pain.
♥️Lateral spinalthalamic tract
♥️Ventral posterior lateral thalamus
♥️Primary and secondary somatosensory cortex
⭐C FIBERS
♥️Transmit diffuse pain information
♥️Drive affective response to pain
♥️Unmyelinated fibers
♥️10 times slower than A-delta fibers
♥️Innervate deep tissues such as muscles, joints and viscera
♥️Generally perceived as slow, dull or aching
♥️Medial spinothalamic, spinoreticular and spinomesencephalic tracts
♥️Medial thalamus
♥️Primary somatosensory cortex & limbic system
⭐ PERIPHERAL NEUROPATHIC PAIN
♥️Pain induced due to injury, disease or mechanical compromise of nerve tissue
Caused by systemic disease, trauma and infections or autoimmune disorders affecting nerve tissue.
⭐CENTRAL SENSITIZATION
♥️Pain disproportionate to injury
Usually non mechanical and unpredictable
Generally wide-spread.
⭐BIOMEDICAL MODEL OF PAIN
♥️Pain will resolve when the tissue damage is fixed.
Non-organic pain considered psychogenic
Doesn't explain new research indicating chronic pain has a physiological source not just psychological.
Is the physical body
⭐BIOPSYCHOSOCIAL MODEL OF PAIN
♥️Physical factors interact with personal and environmental factors to affect body func[on and structure, activity, and participation in life activities.
Takes into account all aspects of the person as a whole.
⭐PAIN BEHAVIORS
♥️Verbal and nonverbal expressions of pain
♥️Guarding and posture positioning
♥️Activity and participation changes
♥️Fear avoidance
♥️Treatment-seeking behavior
⭐RISK FACTORS FOR CHRONIC PAIN
♥️• Up to 50% may be gene[c predisposition
♥️• Women
♥️• Past trauma/abuse
♥️• Psychosocial factors (social support, coping skills, job security, socioeconomic status)
♥️• Depression/psychological distress
♥️• Fear avoidance
♥️• Smoking
♥️• Obesity
♥️• Sleep disorders
• Vitamin D deficiency
⭐CHRONIC PAIN SYNDROME
♥️• Extensive pain behaviors
♥️• Doctor-shopping
♥️• Dependency for multiple medical problems
♥️• Preoccupation with pain
♥️• Passive-dependent personality traits
♥️• Denial of emotional or family conflicts
♥️• Significant life disruption in many areas
♥️• Feelings of isolation and loneliness
♥️• Being demanding, angry, or skeptical
♥️• Lack of insight into self-defeating behaviors
♥️• Use of pain as a symbolic means of communication
⭐INTERVENTIONAL MEDICARE FOR PAIN
♥️• Injections
♥️• Surgical procedures
♥️• Implantable devices
The primary goal in a physical therapy assessment of a patient with chronic pain is..
Identifying biological, psychological, and social factors that may contribute to the patient's experience of chronic pain.The biopsychosocial model is currently considered the most appropriate to evaluate and understand chronic pain because it reflects the interac[on between the biological, psychological, and social influences in a person's experience with pain. A thorough physical therapy assessment should incorporate evalua[on of all aspects of this move
⭐BEST REFLECTS THE PATIENT'S EXPERIENCE OF CHRONIC PAIN
♥️Long-lasting pain of sufficient duration and intensity, adversely affecting a patient's function and quality of life. This definition reflects all domains of the biopsychosocial model in a patient's experience with chronic pain.
⭐A PATIENT IS REFERRED FOR MANAGEMENT OF CHRONIC PAIN IN THE THORACIC REGION. SEVERAL FACTORS HAVE BEEN IDENTIFIED AS CONTRIBUTING TO THE CONDITION, INCLUDING LACK OF EXERCISE, DIAGNOSIS OF DEPRESSION, AND OLDER AGE. TREATMENT WHICH FACTOR SHOULD BE THE PRIORITY GOAL OF PHYSICAL THERAPY MANAGEMENT?
♥️Encouragement of self-management, including increase in exercise.
The goal of treatment of chronic pain should address the secondary pathology and perpetuating factors rather than focus on a presumed initial pathology, which might no longer be present. There is evidence that therapeutic exercise is beneficial in the management of chronic pain, and this, in consultation with the patient, is likely to be a goal.
⭐WHAT SOCIETAL GROUP IS MORE LIKELY TO EXPERIENCE CHRONIC PAIN
♥️Older adults, women, people with past trauma[c experiences, and people with a history of mental illness.
Age, gender, heredity, existing mental illness, and history of trauma all predispose a person to experiencing chronic pain.
⭐INTERVENTIONAL THAT IS MULTIDISCIPLINARY IS MORE EFFECTIVE THAN MONO DISCIPLINARY MANAGEMENT FOR THE PATIENT WITH CHRONIC PAIN. What is the most effective decision regarding the structuring of the team?
♥️The patient should be involved in the structuring of the team.
Although there is some evidence that a multidisciplinary approach is more effective than a single discipline, there is no current evidence that a multidisciplinary team should consist of any specific discipline. Encouraging the patient's active role in care should be supported by actively engaging in discussion about the possibility of involving other disciplines.
⭐BEST REPRESENTS THE GOAL OF MEDICAL MANAGEMENT IN CHRONIC PAIN
♥️Assessment and treatment of body structures, body functions, and participation in life activities.
The goal of any intervention is to assess and appropriately treat a patient for any limita[on in the classification of the World Health Organization-International Classification of Functioning, Disability and Health (WHO-ICF)
⭐⭐⭐⭐⭐.WHAT IS CHRONIC PAIN ?
⭐PAIN
♥️An unpleasant sensory and emotional experience associated with actual or potential tissue damage or psychological origin
⭐ACUTE PAIN
♥️Associated with tissue damage and resolves as the tissue heals. Usually associated with physiological signs of distress. Sweating, pallor, nausea, increased heart rate. Pain is proportional to tissue damage. Resolved when nociceptive causes are addressed.
⭐RECURRENT PAIN
♥️Repeated episodes of acute pain. Repeated episodes of low back strain, migraine headaches
⭐CHRONIC PAIN
♥️Pain that persists past the healing phase following an injury; impairment is greater than anticipated based on the physical findings or injury and occurs in the absence of observed tissue injury.
⭐TRIGGERING MECHANISM CLASSIFICATION OF PAIN
♥️Nociceptive
♥️Peripheral neuropathic
♥️Central sensitization
⭐NOCICEPTIVE PAIN
♥️Pain that is localized to an area of injury or dysfunction.
♥️Pain is aggravated or eased with movement or positions
♥️Clear mechanical trigger
⭐A- DELTA FIBERS
♥️Transmit detailed somatosensory information
♥️5-10 times slower than other sensory receptors for touch, pressure, proprioception, muscle spindles, and Golgi tendon organs.
♥️Generally innervate cutaneous structures
♥️Generally produce sharp, localized pain.
♥️Lateral spinalthalamic tract
♥️Ventral posterior lateral thalamus
♥️Primary and secondary somatosensory cortex
⭐C FIBERS
♥️Transmit diffuse pain information
♥️Drive affective response to pain
♥️Unmyelinated fibers
♥️10 times slower than A-delta fibers
♥️Innervate deep tissues such as muscles, joints and viscera
♥️Generally perceived as slow, dull or aching
♥️Medial spinothalamic, spinoreticular and spinomesencephalic tracts
♥️Medial thalamus
♥️Primary somatosensory cortex & limbic system
⭐ PERIPHERAL NEUROPATHIC PAIN
♥️Pain induced due to injury, disease or mechanical compromise of nerve tissue
Caused by systemic disease, trauma and infections or autoimmune disorders affecting nerve tissue.
⭐CENTRAL SENSITIZATION
♥️Pain disproportionate to injury
Usually non mechanical and unpredictable
Generally wide-spread.
⭐BIOMEDICAL MODEL OF PAIN
♥️Pain will resolve when the tissue damage is fixed.
Non-organic pain considered psychogenic
Doesn't explain new research indicating chronic pain has a physiological source not just psychological.
Is the physical body
⭐BIOPSYCHOSOCIAL MODEL OF PAIN
♥️Physical factors interact with personal and environmental factors to affect body func[on and structure, activity, and participation in life activities.
Takes into account all aspects of the person as a whole.
⭐PAIN BEHAVIORS
♥️Verbal and nonverbal expressions of pain
♥️Guarding and posture positioning
♥️Activity and participation changes
♥️Fear avoidance
♥️Treatment-seeking behavior
⭐RISK FACTORS FOR CHRONIC PAIN
♥️• Up to 50% may be gene[c predisposition
♥️• Women
♥️• Past trauma/abuse
♥️• Psychosocial factors (social support, coping skills, job security, socioeconomic status)
♥️• Depression/psychological distress
♥️• Fear avoidance
♥️• Smoking
♥️• Obesity
♥️• Sleep disorders
• Vitamin D deficiency
⭐CHRONIC PAIN SYNDROME
♥️• Extensive pain behaviors
♥️• Doctor-shopping
♥️• Dependency for multiple medical problems
♥️• Preoccupation with pain
♥️• Passive-dependent personality traits
♥️• Denial of emotional or family conflicts
♥️• Significant life disruption in many areas
♥️• Feelings of isolation and loneliness
♥️• Being demanding, angry, or skeptical
♥️• Lack of insight into self-defeating behaviors
♥️• Use of pain as a symbolic means of communication
⭐INTERVENTIONAL MEDICARE FOR PAIN
♥️• Injections
♥️• Surgical procedures
♥️• Implantable devices
The primary goal in a physical therapy assessment of a patient with chronic pain is..
Identifying biological, psychological, and social factors that may contribute to the patient's experience of chronic pain.The biopsychosocial model is currently considered the most appropriate to evaluate and understand chronic pain because it reflects the interac[on between the biological, psychological, and social influences in a person's experience with pain. A thorough physical therapy assessment should incorporate evalua[on of all aspects of this move
⭐BEST REFLECTS THE PATIENT'S EXPERIENCE OF CHRONIC PAIN
♥️Long-lasting pain of sufficient duration and intensity, adversely affecting a patient's function and quality of life. This definition reflects all domains of the biopsychosocial model in a patient's experience with chronic pain.
⭐A PATIENT IS REFERRED FOR MANAGEMENT OF CHRONIC PAIN IN THE THORACIC REGION. SEVERAL FACTORS HAVE BEEN IDENTIFIED AS CONTRIBUTING TO THE CONDITION, INCLUDING LACK OF EXERCISE, DIAGNOSIS OF DEPRESSION, AND OLDER AGE. TREATMENT WHICH FACTOR SHOULD BE THE PRIORITY GOAL OF PHYSICAL THERAPY MANAGEMENT?
♥️Encouragement of self-management, including increase in exercise.
The goal of treatment of chronic pain should address the secondary pathology and perpetuating factors rather than focus on a presumed initial pathology, which might no longer be present. There is evidence that therapeutic exercise is beneficial in the management of chronic pain, and this, in consultation with the patient, is likely to be a goal.
⭐WHAT SOCIETAL GROUP IS MORE LIKELY TO EXPERIENCE CHRONIC PAIN
♥️Older adults, women, people with past trauma[c experiences, and people with a history of mental illness.
Age, gender, heredity, existing mental illness, and history of trauma all predispose a person to experiencing chronic pain.
⭐INTERVENTIONAL THAT IS MULTIDISCIPLINARY IS MORE EFFECTIVE THAN MONO DISCIPLINARY MANAGEMENT FOR THE PATIENT WITH CHRONIC PAIN. What is the most effective decision regarding the structuring of the team?
♥️The patient should be involved in the structuring of the team.
Although there is some evidence that a multidisciplinary approach is more effective than a single discipline, there is no current evidence that a multidisciplinary team should consist of any specific discipline. Encouraging the patient's active role in care should be supported by actively engaging in discussion about the possibility of involving other disciplines.
⭐BEST REPRESENTS THE GOAL OF MEDICAL MANAGEMENT IN CHRONIC PAIN
♥️Assessment and treatment of body structures, body functions, and participation in life activities.
The goal of any intervention is to assess and appropriately treat a patient for any limita[on in the classification of the World Health Organization-International Classification of Functioning, Disability and Health (WHO-ICF)
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