Modalities: Concepts Of Pain/cryotherapy (1B)

Front 1

Spinoparabrachial Tract consists of:

Back 1

the affective component of pain

Front 2

Spinoreticular Tract consists of:

Back 2

1. Modulation of pain
2. Motivational, emotional, unpleasant component of pain

Front 3

Spinohypothalamic-Limbic Tract consists of:

Back 3

Autonomic adjustments to pain

Front 4

Anterolateral Systems "Take Home" message is that is has:

Back 4

1. Multiple ascending pathways
2. Ipsilateral, contralateral, bilateral
3. Redundant system

Front 5

Names the Different States of pain:

Back 5

1. Acute Pain
2. Referred Pain
3. Persistent Pain

Front 6

Acute Pain is:

Back 6

Sharp
Localized
Rapid onset
Short duration (usually)
Warning of tissue damage (actual or potential)

**A Delta is most responsible for this**

Front 7

Referred Pain is:

Back 7

Pain at a site remote from the source of pathology & occurs due to convergence

Brain unable to decipher or determine where pain is coming from

Ex. Heart Attack

Front 8

Persistent Pain is:

Back 8

Pain that is recurrent or episodic

May accompany a re-injury or associated chronic condition

Ex. Someone with poor posture can cause neck pain (It comes and goes)

Front 9

You can assess pain by:

Back 9

1. Numerical
2. Verbal rating scale
3. Visual analog scale

Front 10

Assessment Scales should include:

Back 10

Severity
Location
Quality
Observation of non verbal cues
Mode, duration of onset
Provocating and relieving factors

**look for non-verbal cues

Front 11

Numerical Pain Scale Is:

Back 11

Give pt 0 to 10
Qualify numbers
What is zero, what is ten

Front 12

Verbal Rating Scale is:

Back 12

No pain, mild, moderate, etc.

Front 13

Visual Analog Scale is:

Back 13

Number line, or Faces for Kids!

Front 14

Abnormal Pain can be:

Back 14

1. Allodynia
2. Hyperalgesia
3. Neuropathic
4. Chronic Pain

Front 15

Parallel Ascending Pathways of Pain are from

Back 15

spinal cord to higher centers

Front 16

Parallel Ascending Pathways of Pain have Multiple Pathways and they are what?

Back 16

Spinothalamic Tract, Spinomesencephalic tract, Spinoparabrachial tract, Spinoreticular tract, Spinohyphothalamic-limbic tract

Front 17

Parallel Ascending Pathways of Pain are also known as:

Back 17

Anterolateral System

Front 18

Spinothalamic Tract has what actions involving in it:

Back 18

Discrimitive pain
Temperature
Crude touch
Pressure

Front 19

Spinomesencephalic Track has:

Back 19

Pain modulation
Sensorimotor integration of pain
Motor reflex to pain

Front 20

What does Ipsilateral, Contralateral, and Bilateral mean:

Back 20

Ipsilateral-SAME SIDE
Contralateral-OPPOSITE
Bilateral- Both side at the same time!!!

Front 21

Pain States Consist of:

Back 21

Pain sensation increases when painful stimulus persists

This can lead to pathologic pain states, where pain persists without the initial trauma.

Front 22

How many points on a Scale can you move up and down to see a difference in someone pain level?

Back 22

If pain decreases by 2, you are making a difference in their pain for the better

Increase by 2 (makes it worse), It is important to access it each visit when you see them

Front 23

Cold Modalities are:

Back 23

One of the most effective and least expensive modes of acute injury and pain management

Front 24

What 3 things does cryotherapy cause the body to do?

Back 24

Decreased swelling, vasoconstriction,
Decrease muscle spasm so should have more ROM
Decrease pain

Front 25

In Cryotherapy, you want to _______ blood flow and metabolism __________ bleeding and inflammation (acute swelling)

Increase/Decrease?

Back 25

Decrease; Decreased

Front 26

In Cryotherapy, you want to ________ in muscle spasm allows for _________ pain free ROM


Increase/Decrease?

Back 26

Decrease; Increase

Front 27

Does pain threshold increase or decrease?

Back 27

Increase

Front 28

Conduction is:

Back 28

transfer of energy through direct contact

Front 29

Convection is:

Back 29

what would occur if you had them in a cold whirlpool

In something moving around; Gravity depended position will cause more swelling

Front 30

Evaporation is:

Back 30

sweat

The cooler substance pulls the heat out, then evaporates off the skin.

**Cooler substance cooling it off like Cooling spray

Front 31

In Cryotherapy, cooling is accomplished by:

Back 31

removing heat from an object

**Actually removing the heat not adding cold

Front 32

Thermal conductivity is the:

Back 32

Efficiency of a material or tissue to conduct heat

**Metals more efficient than non-metals

Front 33

Conduction transfer of heat by:

Back 33

Direct interaction of the molecules in the warmer area with those in the cooler area

Ex. Ice packs, cold water immersion, ice water filled cuffs

Front 34

Tissues with higher water content have better thermal conductivity like:

Back 34

Muscles better than adipose tissue

Adipose (fat) tissue serves as an insulator and resists heat transfer (gains or losses)

Muscles generally sit under adipose tissue

Front 35

With application of cold therapies the patients will experience 4 different stages, what are they?

Back 35

1. Cold
2. Burn
3. Ache
4. Numbness

Ex. Ice Massage

**Make sure you explain to your patients what is going to happen!!

Front 36

Factors Influencing Cold Therapy Response are:

Back 36

1. Temperature difference between cold object and soft tissue
2. Time of exposure
3. Thermal conductivity
4. Type and size of cooling agent
5. Body surface to be covered
6. Activity level
7. Ability of cooling agent to maintain its temperature

Front 37

Arterial blood is warmer than venous and with _______ blood flow you get ________ arterial blood

Increase/Decrease?

Back 37

Decrease; Decreased

Front 38

The energy transfer between arteries and veins increase/decrease?

Back 38

Decrease

**Arteries and veins are close to each other

Front 39

Convection is:

Back 39

Direct connection between skin and moving fluid

Rarely used because machines are expensive, bulky, big

Ex. Cold whirlpool, Specific heat of water

Front 40

Convection is not encouraged in the Acute Phase of Healing, Why?

Back 40

Because you DO NOT want to put heat on an ankle sprain right away, puts the extremity in a dependent position- increase EDEMA!!!

Front 41

Heat loss in Convection is:

Back 41

25 x greater in water versus air

**Heat abstraction occurs a lot faster than cold

Front 42

Vapocoolant Spray is:

Back 42

1. Used for pain relief for trigger points before stretch

**Volatile liquids, Evaporates immediately, Upon contact with skin it extracts heat

Front 43

Vapocoolant is applied in:

Back 43

sweeping strokes

**Temp can drop by 15 degrees C

Front 44

Hemodynamic Effects of Cold Agents are:

Back 44

1. Immediate response is vasoconstriction of cutaneous blood vessels
2. Vessel diameter most significant factor relating to blood flow
3. Exposure to cold therapy for 15 minutes or less
4. Vasoconstriction of arterioles and venules
5. Posttraumatic Edema and Inflammation
6. First 24-72 hours cold is usually the modality of choice

Front 45

Peripheral Nerve Effects are:

Back 45

1. Cold alters conduction velocities
2. May also cause failure to conduct impulses

**Cooling to 56° F blocked conduction of A fibers, Lower than 56 to block C fibers

Some cases of neurapraxia and axonotmesis

Front 46

Neuropraxia is:

Back 46

Failure of nerve conduction blocked without structural damage – 1hr of ice
Temporary condition, effects usually reversed in 6-8 weeks
Least serious

Front 47

Axonotmesis is:

Back 47

discontinuity of axons, but endo, peri,

Front 48

Epineurium Intact you should:

Back 48

Ice for 2hrs
More severe than neuropraxia
Long lasting & more dangerous
Irreversible

Front 49

What are the effects of Cryotherapy on the muscle?

Back 49

1. Debate is whether to ice before or after
2. Increase in strength after 5 minutes of ice massage
3. Decrease in strength after 30 minutes of immersion in 10 to 12 degrees C (Possibly due to decreased muscle blood flow, Strength then increased)

Front 50

Neuromuscular Effects can:

Back 50

help reduce spasticity

**Seen with increased DTR and with clonus; Effects temporary

Front 51

Primary Goals of Cryotherapy are to:

Back 51

Limit edema
Reduce pain
Muscle relaxation/ contraction
Limit secondary hypoxic tissue injury

Front 52

What does RICE or PRICE mean?

Back 52

Protection
Rest
Ice
Compression
Elevation

Front 53

Cryokinetics, you should:

Back 53

should be apply cold for a maximum of twenty minutes to numb the area

Process can be repeated for 5 minutes to 're-numb' the area if necessary

Exercises performed during cryokinetics are active & should be gradually increased in intensity providing they remain pain free

Front 54

Myofascial Pain is:

Back 54

referred from active myofascial trigger points with associated dysfunction

Trigger points present in skin, ligaments, and fascia

May be related to muscle strain
Trigger points found via digital pressure

Ex. Stretch & spray, ice massage, deep pressure

Front 55

In Cryotherapy, Spasticity goal is to:

Back 55

1. Decrease tone to allow for increased movement
2. Cold applied over the hypertonic muscle for 10 to 30 minutes
3. Various methods used
4. Effects last approx 1 to 1.5 hrs

Front 56

You want to use cold for how long for spasticity:

Back 56

10-30 minutes

**Low load, long duration stretch is best for spasticity; Don’t want to excite the muscle spindle

Front 57

Guidelines for Use, you need to be:

Back 57

1. Familiar w/ medical history & status like Contraindications
2. Time post injury
3. Consider safety Ex. Try small region first; Avoid potential stresses of tissue for approximately 2 hours

Front 58

Cold Packs are? and How do you use them?

Back 58

Inexpensively purchased or easily made

Uses:
1. For hygiene, use layer of towel
2. Be careful with chemical ice packs (packs that must be popped), as the chemicals can burn skin if exposed.
3. Gel packs typically stay cool for 15 to 20 minutes

Front 59

Ice Massage is?

Back 59

Typically done over small region

Ex. Muscle belly, tendon, bursa, trigger points

Front 60

How do you do Ice Massage:

Back 60

1. Freeze water in paper or foam cup or use commercially available ice massage cups
2. A 10 by 15 cm region may be covered in 5 to 10 minutes
3. Use small overlapping circles

Front 61

During Ice Massage there are 4 sensations that should happen (Intense Cold, Burning, Aching, Numbness CBAN) and the Burning and Aching should pass in approx., how many minutes?

Back 61

1-2 minutes

Front 62

Cold Baths are:

Back 62

Used to cool distal extremities
Water temps range from 13 to 18 degrees C
Lower temps correlate with shorter immersion times
Basin of cold water and ice is sufficient

Front 63

Vapocoolant Spray you want to:

Back 63

1. Position patient to facilitate relaxation
2. Muscle is put on passive stretch
3. Spray in unidirectional motion
4. Over trigger point
5. Over referred pain regions

Front 64

Cold Gels are:

Back 64

Creams that give perceived sensation of cold
Easy to apply
Very portable
No need for refrigeration

Ex. BioFreeze

Front 65

Polar Packs/Game Ready are for:

Back 65

Acute musculoskeletal injuries
Status post surgery
Range from 10 to 25 deg C
Intermittently inflated to push edema out of region

Front 66

Contraindications for Cryotherapy are:

Back 66

Uticaria
Cold Intolerance
Cryoglobulinemia
Raynaud’s Disease
Over a regenerating peripheral nerve
Over an area of circulatory compromise
Over an area of peripheral vascular disease

Front 67

Uticaria:

Back 67

pt. has allergic reaction to cold (hives)

Front 68

Cold Tolerance:

Back 68

pt. doesn’t like the cold

Front 69

Cryoglobulinemia is:

Back 69

abnormal blood protein forms gels when exposed to cold. Can lead to ischemia or gangrene

**Patient should know this prior to therapy

Front 70

Raynaud's Disease is:

Back 70

Vasospastic disorder, cooler than 60 degrees. Shunting blood away

**Over a regenerating peripheral nerve – you want it to regenerate

Front 71

Precautions for Cryotherapy are:

Back 71

Hypertension
Over a superficial peripheral nerve (danger of neuropraxia)
Over an open wound
Poor sensation (can't feel how bad it can hurt)
Poor cognition (doesn't understand you)
Very young or very old (typically like heat)
Aversion to cold (doesn't care for cold)

Front 72

How do you know Cryotherapy is working?

Back 72

ROM increased
Decrease swelling
Perceived pain (how well it feels)
Girth measurement

Front 73

What are the Parameters you need to document when giving cryotherapy?

Back 73

Type of agent
Time on it
Location
Position
Temp
Use anything to help compress it
Skin color after
How they are seating/laying

Front 74

You should always be aware of the changes in the patients response by:

Back 74

1. Beneficial or adverse
2. Skin color

Front 75

Case Study # 1

A 17 year old male is referred with a diagnosis of acute grade II right lateral ankle sprain that occurred 12 hours prior. After the examination he demonstrated notable effusion throughout the right ankle, (lateral>medial) decreased AROM, and pain that increases with AROM or PROM and while WB.

1. Does the pt. have a dysfunction, limitation, or problem that can be improved with the use of cryotherapy?

2. What type of cryotherapy could be used and what specific parameters are appropriate?

Back 75

1.Yes, pain can be reduced allowing more ROM, resistive exercise and increase WB to complete normal gait cycle, swelling can be reduced.

2. Until numbness to the area is felt, icepack, ice bath,

Front 76

Case Study #2

Back 76

Look at in the Powerpoint (last slide in Cryotherapy)