NMS 2006
Terms
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- visual analog scale
- Pain rating from 1-10
- Acute Pain
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<6months
Your "Warning signal"
Evidence for nociception
Responds to analgesics
Causes anxiety - Chronic Pain
- Pain lasting longer than healing process
- Neuropathic Pain
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due to nerve injury(ischemia, cutting)
Burning, tingling, stabbing, shooting, electrical
Responds to interventional - Cancer Pain
- related to malignant disease or tumors effects on body
- Nociceptive Pain (2 types)
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Somatic Pain - localized sharp, aching, throbbing
Visceral - diffuse pain.
Responds to NSAIDS, nerve blocks. - Biological Process of Generating Pain
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Transduction (nerve endings --> dorsal horn)
Transmission (dorsal horn --> spinothalamic --> thalamus)
Modulation (thalamus --> cortex --> descending pathways)
Cortex percieves stimuli
--> CREATES pain sensation
--> inhibits thru decsending
--> activates withdrawl
spinthalamic = stim path
descending = inhibitory - Treatments of Pain
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Can block transduction (lidocaine patch), transmission (nerve blocks), modulation (intrathecal), or modulate perception.
Non-invasive vs. Invasive
Use step-wise treatment - Acute (Tendonitis)
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D: Inflammatory cell response with microtears & vascular degeneration
H: fibroblastic prolif, hemorrhage, granulation tissue
Peritendonitis
Periostitis - Chronic (Tendinosis)
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D: Degeneration w/o inflammatory
H: Collagen disorganization; focal necrosis and calcification; can see myofiroblasts
Angiofibroblastic Hyperplasia - Overuse Tendinosis vs Overuse Tendinitis
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Tendinosis - longer recovery, less likely of recovery to sports, therapy = encourage collagen-synth and maturation & surgery to excise abnormal tissue
Teninitis - therapy = antiinflammatory - Paratenonitis
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D: Inflammation of outer layer of tendon
H: Mucoid degeneration in areolar tissue - Paratenonitis w/ Tendinosis
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D: Paratenonitis w/ intratendinous degeneration
H: collagen disorganization & mucoid - Tendonitis & Bursitis Symptoms
- Pain; aggravation; tenderness over area; pain w/ resised movements or compression
- Tendonitis & Bursitis Treatment
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1)diagnose
2)PRICE - Protection; relative rest; ice; compression; elevation. (& anti-inflams)
3)eccentric strenghthening & closed kinetic chain exercises
Steroids are controversial. side effects = psychosis, ulcers, avascular necrosis, diabetes, necrosis (w/injection), and injectables not always reabsorbed. - Functional Biochemical Deficit & Functional Adaptation Complex
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Biochemical - inflexibilities or imbalances that creat altered mechanics
Adaptation - substitutions used by patient - Lateral Epicondylitis
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Tennis Elbow
-extensor tendons insert at lateral epicondyles
-involves more than tendon
-tender to palpation
-pain w/ gripping, wrist & middle finger extension
Treat w/ PRICE, NSAID, ROM, steroids,surgery. - Hyperalgesia
- increased response to painful stimulus
- Allodynia
- Pain from stimulus that does not usually provoke pain
- Dysesthesia
- unpleasant abnormal sensation
- Hyperesthesia
- increasted sensitivity to stimulation
- Hyperpathia
- painful syndrome w/ increased rxn to stimulus, esp. repetative stimuli. there is an increased threshold.
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Complex Regional Pain Syndrome
Type 1 -
Reflex Sympathetic Dystrophy
Noxious event --> spontaneous pain or allodynia / hyperalgesia, multiple nerve areas, edema, skin blood flow or sudomotor abnormality
Can have viscious circle of nociceptor input activating multiple autonomic/somatic actions. -
Complex Regional Pain Syndrome
Type II -
Causalgia
**Nerve injury** --> spontaneous pain or allodynia/hyperalgesia, not necessarily limited to nerve territory, edema, skin blood flow and sudomotor abnormalities.
Has SMP - Sympathetically Maintained Pain (SMP)
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A consequence of Causalgia.
Cutaneous nociceptors of damabed nerve become excited by sympathetic efferents (NE) because of possible dennervation hypersensitvity and upregulation of NE receptors. - Neurogenic Inflammation
- In CRPS, both axon reflex vasodilation and protein extravasation increases.
- Malingering
- intentional production of false or exaggerated conditions for external incentives
- Nociception
- activation of A-delta and C fibers indicating adverse effects usually associated w/ tissue damage
- Pain
- sensation arising from precieved nociception
- Chronic Non-Malignant Pain
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>several months
No evidence of nociception or tissue damage
No well response to analgesics
Hopelessness and despair
Diffuse pain
Etiology idiopathic - Operant Conditioning
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Noxious stimulus <--> Pain behavior <--> reinforcement
If people get reinforced for pain behavior, theory suggests behavior continues even w/ no pain!
Reinforcements(Chronic Pain): avoidance of undesirable taskes, more attention, opiods, etc. - Pavlovian Conditioning
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bell --> bring food --> dog salivates
bell --> dog salivates - Cognitive Behavioral Therapy
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If injured people fear reinjuy and obtain disuse depression = viscious cycle.
CBT helps pts recognize behaviors and overcome fear & depression. - Self Efficacy
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High = one can manage challenging situation
Low = less likely to engage in adaptive coping behaviors
TEACH SELF EFFICACY - Recommendations for LBP Treatment
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a. Beneficial Treatments: exercise therapy, behavioral therapy, multidisciplinary programs
b. Likely to be Beneficial Treatments: analgesics, back schools in occupational settings, massage (including OMT), and NSAIDS
c. Unlikely to be Beneficial: bed rest, EMG biofeedback
d. Ineffective or harmful: facet joint injections, traction