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37 Cards in this Set

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visual analog scale
Pain rating from 1-10
Acute Pain
Quick resolving pain from injury, inflammation, surgery, childbirth
Chronic Pain
Pain lasting longer than healing process
Neuropathic Pain
from diseases of or injury to the nerves
Cancer Pain
related to malignant disease or tumors effects on body
Nociceptive Pain (2 types)
Somatic Pain - localized sharp, aching, throbbing
Visceral - diffuse pain.
Responds to NSAIDS, nerve blocks.
Neuropathic Pain
due to nerve injury(ischemia, cutting)
Burning, tingling, stabbing, shooting, electrical
Responds to interventional
Biological Process of Generating Pain
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
Can block transduction (lidocaine patch), transmission (nerve blocks), modulation (intrathecal), or modulate perception.

Non-invasive vs. Invasive

Use step-wise treatment
Acute (Tendonitis)
D: Inflammatory cell response with microtears & vascular degeneration
H: fibroblastic prolif, hemorrhage, granulation tissue


Peritendonitis
Periostitis
Chronic (Tendinosis)
D: Degeneration w/o inflammatory
H: Collagen disorganization; focal necrosis and calcification; can see myofiroblasts

Angiofibroblastic Hyperplasia
Overuse Tendinosis vs Overuse Tendinitis
Tendinosis - longer recovery, less likely of recovery to sports, therapy = encourage collagen-synth and maturation & surgery to excise abnormal tissue
Teninitis - therapy = antiinflammatory
Paratenonitis
D: Inflammation of outer layer of tendon
H: Mucoid degeneration in areolar tissue
Paratenonitis w/ Tendinosis
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
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
Biochemical - inflexibilities or imbalances that creat altered mechanics

Adaptation - substitutions used by patient
Lateral Epicondylitis
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.
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)
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
Acute Pain
<6months
Your "Warning signal"
Evidence for nociception
Responds to analgesics
Causes anxiety
Chronic Non-Malignant Pain
>several months
No evidence of nociception or tissue damage
No well response to analgesics
Hopelessness and despair
Diffuse pain
Etiology idiopathic
Operant Conditioning
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
bell --> bring food --> dog salivates

bell --> dog salivates
Cognitive Behavioral Therapy
If injured people fear reinjuy and obtain disuse depression = viscious cycle.
CBT helps pts recognize behaviors and overcome fear & depression.
Self Efficacy
High = one can manage challenging situation
Low = less likely to engage in adaptive coping behaviors
TEACH SELF EFFICACY
Recommendations for LBP Treatment
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