Ptha 1431 - Physical Agents In Rehabilitation - Cameron Book And Stetz Lecture - Exam 1

Front 1

What does the term "thermal" pertain to? ***

Back 1

heat

Front 2

What is thermotherapy? ***

Back 2

adding heat to the body

Front 3

What is cryotherapy? ***

Back 3

removing heat from the body; the therapeutic use of cold

Front 4

How does application of cold work? ***

Back 4

by removing heat from the body

Front 5

What are the superficial thermotherapy agents? ***

Back 5

hot packs, paraffin, and fluidotherapy

Front 6

How deep does the heat go with superficial heating agents? ***

Back 6

approximately 0.5 cm (about 0.2 inches)

Front 7

What are the deep heating thermotherapy agents? ***

Back 7

ultrasound and diathermy

Front 8

How deep does the heat go with deep heating agents? ***

Back 8

approximately 3 - 5 cm (about 1.2 to 2 inches)

Front 9

What is specific heat? ***

Back 9

the amount of energy required to raise the temperature of 1 gram of material 1 degree Celsius

Front 10

How does the composition of an item affect its specific heat? ***

Back 10

materials with a high specific heat require more energy to heat up and hold more energy at a given temperature than materials with a low specific heat.

Front 11

How is specific heat expressed? ***

Back 11

in Joules per gram per degree Celsius (J/g/C)

Front 12

What is the average specific heat for the human body? ***

Back 12

3.56 J/g/C

Front 13

Rank the following from highest to lowest specific heat:
bone, fat, muscle, skin. ***

Back 13

skin - 3.77 J/g/C
muscle - 3.75 J/g/C
fat - 2.30 J/g/C
bone - 1.59 J/g/C

Front 14

Which has a higher specific heat, air or water? ***

Back 14

water - 4 J/g/C
air - 1 J/g/C

Front 15

How are thermal agents with a high specific heat applied to patients?

Back 15

thermal agents with a high specific heat (e.g., water) are applied at a lower temperature than those with a lower specific heat (e.g., air--fluidotherapy)

Front 16

What is thermal conductivity? ***

Back 16

the rate at which heat transfers by conduction between two materials

Front 17

Which has greater thermal conductivity, bone/muscle or fat? ***

Back 17

bone and muscle - 0.001 cal/sec
fat - 0.0005 cal/sec

Front 18

Name five factors that influence the extent of temperature change in the target tissue.
***

Back 18

- conductivity of agent and tissue,
- amount of area treated,
- time of exposure,
- temperature difference between thermal agent and target tissue, and
- intensity of the agent

Hint 18

CATTI

Front 19

By what five modes of transfer may heat be transferred to, from, or within the body? ***

Back 19

conduction
convection
conversion
radiation
evaporation

Hint 19

CCCRE

Front 20

How does heat flow when using a conduction method of thermotherapy? ***

Back 20

from the material at the higher temperature to the material at the lower temperature; there must be a temperature gradient (i.e., if the two materials are at the same temperature, no conduction will occur)

Front 21

How does conduction work at the molecular level?

Back 21

energy exchange by direct collision between molecules of two materials at different temperature; the molecules from the warmer material cause the molecules in the cooler material to accelerate

Front 22

What is required for conduction? ***

Back 22

direct contact

Front 23

How long does heat transfer in conduction continue?

Back 23

until the temperature (and speed of molecular movement) of both materials become equal

Front 24

Heat transfer by conduction occurs only between:

Back 24

materials of different temperatures that are in direct contact with each other

Front 25

What happens if there is air between a conductive thermal agent and the patient?

Back 25

the heat is first conducted from the thermal agent to the air, and then from the air to the patient

the heat transfer is much less effective (this also more closely resembles radiation)

Front 26

Upon what does the rate at which heat is transferred by conduction between two materials depend?

Back 26

- temperature difference between the materials,
- area of contact, and
- thermal conductivity of the materials

Front 27

What are four methods for increasing/decreasing rate of heat transfer between two materials?

Back 27

- increase/decrease the temperature difference between the materials;
- use material with higher/lower level of thermal conductivity;
- treat a larger/smaller area;
- alter the composition of the agent (e.g., ice causes more rapid cooling than water, even at the same temperature)

Front 28

Per Cameron, how many layers go between a patient and a hot pack?

Back 28

6 to 8 layers

Front 29

Why is the age of the towel used to wrap a hot pack something to consider?

Back 29

newer towels will have more fibers and be less conductive; older towels will likely conduct more heat

Front 30

Why should jewelry be removed from an area treated with a conductive thermal agent?

Back 30

to avoid overheating or cooling the skin in contact with the metal (metal being an excellent thermal conductor)

Front 31

Why does ice have tremendous thermal conductivity?

Back 31

it takes a lot of energy (which it will pull from the patient) to convert ice to water

Front 32

What is an important consideration to remember about cold packs?

Back 32

different brands use different materials. Do not assume they can all be applied using the same method, time, or layers of insulation.

Front 33

How does heat transfer by convection work? ***

Back 33

through mass motion of a circulating medium (liquid, gas, etc.), usually in a closed system (e.g., fluidotherapy)

Front 34

Which method transfers more heat: conduction or convection? Why?

Back 34

convection, because as the agent circulates, new material at the initial treatment temperature keeps coming into contact with the patient's body part

Front 35

How does blood circulating in the body transfer heat?

Back 35

by convection

blood that is warmer or cooler than the treatment area will bring heat in or take it away with circulation at each heartbeat

Front 36

What is vasodilation?

Back 36

an increase in diameter of blood vessels that increases the rate of circulation, thus increasing the rate at which the tissue temperature returns to normal

Front 37

Why is impaired circulation a concern when applying thermal agents?

Back 37

because the reduced circulation will not bring warmer/cooler blood into the treatment area as effectively and tissue could become too cold/warm

risk of thermal injury is increased

Front 38

What is conversion? ***

Back 38

heat transfer by conversion involves converting a nonthermal form of energy (electrical, mechanical, acoustic, chemical, etc.) into heat

Front 39

How does ultrasound work?

Back 39

it converts mechanical ultrasound energy into heat when it is applied to an absorbent tissue

the tissue vibrates, causing friction, which generates heat and increases tissue temperature.

Front 40

What factors affect rate of heat transfer when using conversion?

Back 40

- power of the energy source (Watts = J/sec)
- size of the area being treated
- size of the applicator
- the efficiency of transmission from applicator to patient
- type of tissue being treated

Front 41

Does conversion require direct contact?

Back 41

no, but an intervening material must be a good transmitter of that type of energy (e.g., ultrasound gel)

Front 42

What is radiation? ***

Back 42

direct transfer and absorption of (electromagnetic) energy without the need for contact or an intervening material

requires a temperature gradient

Front 43

What affects the rate of temperature increase caused by radiation?

Back 43

- intensity of the radiation,
- relative sizes of the source and area being treated,
- distance of the source from the treatment area, and
- angle of the radiation to the tissue

Front 44

What is evaporation? ***

Back 44

a heat exchange that occurs when liquid changes to gas or vapor; results in cooling

Front 45

What are thermotherapy's primary uses? ***

Back 45

- control pain,
- increase soft tissue extensibility (ROM) and circulation,
- decrease stiffness, and
- accelerate healing (by increasing oxygen to tissues)

Front 46

What hemodynamic effect does thermotherapy have?

Back 46

causes vasodilation, thus an increase in the rate of blood flow

Front 47

Where does vasodilation occur during thermotherapy?

Back 47

in the treated area, but to a lesser degree, systemically, in areas distant from the application.

Front 48

What benefit can whole-body thermotherapy have?

Back 48

generalized vasodilation can improve vascular endothelial function in patients with cardiac risk factors and in chronic heart failure, and has been shown in vitro to promote growth of new blood vessels in the heart.

Front 49

By what means does thermotherapy cause vasodilation?

Back 49

- causing inflammation that promotes vasodilator (histamine and prostaglandin) release
- through cutaneous thermoreceptors that either:
a) relax the smooth muscles in the vessels, or
b) activate spinal cord dorsal root ganglion and sympathetic adrenergic activation

Front 50

How can distant vasodilative effects of thermotherapy be used to increase cutaneous blood flow where it is difficult or unsafe to apply direct heat?

Back 50

e.g., if a patient has an ulcer on his leg due to arterial insufficiency, thermotherapy to the lower back could be used to facilitate wound healing through vasodilation.

Front 51

How is blood flow in skeletal muscles affected by superficial heating?

Back 51

superficial heating generally doesn't penetrate deeply enough to affect skeletal muscle blood flow; exercise or deep-heating modalities are required

superficial heating agents do not heat to the depth of most muscles

Front 52

What neuromuscular effects are seen with thermotherapy?

Back 52

- collagen tissue extensibility increases,
- muscle strength changes,
- metabolic rate increases,
- nerve conduction velocity increases,
- nerve conduction firing rate decreases for type II muscle spindles, and increases for type Ib fibers from GTOs (this is thought to reduce muscle spasm and increase relaxation), and
- pain threshold increases

Hint 52

CMMNNP

Front 53

Why should caution be used when applying thermotherapy to demyelinated peripheral nerves (such as in carpal tunnel syndrome or multiple sclerosis)?

Back 53

because the nerve could undergo a conduction block

Front 54

How is thermotherapy thought to increase the pain threshold?

Back 54

- by activation of the spinal gating mechanism, and later
- through reduction of ischemia and muscle spasm, or
- facilitation of tissue healing

Front 55

What effects does thermotherapy have on muscular strength and endurance?

Back 55

it decreases for the 30 minutes following treatment, then increases from the 30-minute to the 2-hour mark;

this is likely due to changes in nerve firing rates initially, followed by an increase in the pain threshold.

Front 56

What must the therapist consider when wishing to gauge muscle strength in a patient undergoing thermotherapy?

Back 56

test the strength before treatment, as initially (the first 30 minutes post-treatment) strength decreases and you won't have a true measurement

Front 57

What metabolic effects does thermotherapy have?

Back 57

it can increase enzymatic biological reactions, cellular biochemical reactions, and oxygen availability, thus increasing oxygen uptake and accelerating healing

however, it may also increase the rate of destructive processes (by increasing activity of collagenase, (e.g., therefore increasing destruction of articular cartilage in RA patients)

Front 58

What is plastic deformation?

Back 58

collagenous soft tissues (such as tendons, ligaments, scar tissues, or joint capsules) that are heated before prolonged stretching increase in length and maintain most of the increase after cooling

Front 59

What is elastic deformation?

Back 59

collagenous soft tissues (such as tendons, ligaments, scar tissues, or joint capsules) that are not heated before prolonged stretching increase in length, but do not maintain most of the increase after the force is removed

Front 60

What is thought to cause plastic deformation?

Back 60

changes in the organization of the collagen fibers and changes in the viscoelasticity of the fibers

Front 61

What is the ideal thermotherapeutic temperature range and time for inducing maximal plastic deformation?

Back 61

maximum increase in residual length is achieved when the tissue temperature is maintained at 40-45° C (104-113° F) for 5 to 10 minutes, and if a low-load, prolonged stretch is applied during the heating period and while the tissue is cooling

(note: this is for cutaneous or superficial tissues; deep-heating agents are required for joint capsules or deep tendons)

(Like the picture on page 156 of an ankle weight on a prone patient receiving thermotherapy to the back of the knee.)

Front 62

What are indications for use of superficial heat? ***

Back 62

- pain control
- increase range of motion
- decrease stiffness
- accelerate healing (by increasing oxygen to tissues)

Front 63

How is the patient's psychological reaction to heat important?

Back 63

possibly the psychological experience of heat as comfortable and relaxing may also influence the patient's perception of pain

Front 64

Is thermotherapy a good option for treatment of acute inflammation or injury?

Back 64

no

initially after injury or inflammation, increase in temperature is likely to aggravate the inflammation (heat, redness, edema)

(some recent studies have shown, however, that heat can reduce pain from acute low back pain, pelvic pain, and renal colic)

Front 65

What are contraindications for thermotherapy? ***

Back 65

- acute injury or inflammation
- thrombophlebitis
- recent or potential hemorrhage
- malignancy
- impaired sensation/mentation

Front 66

What are the precautions for thermotherapy? ***

Back 66

- pregnancy (low back/abdomen--may treat distal extremities)
- impaired circulation (blood vessels may not adequately dilate and carry away heat)
- in those with poor thermal regulation (generally the elderly and very young)
- edema
- cardiac insufficiency (vasodilation increases demands on the heart)
- metal in the area (generally not the deep metal like joint replacement, but shrapnel, bullets, etc.)
- over an open wound
- over areas where topical counterirritants have recently been applied (e.g., Icy Hot--may burn skin), and
- Over demyelinated nerves (may cause nerve block)

Front 67

How does thermotherapy help to accelerate healing?

Back 67

through increasing circulation, which increases delivery of blood and oxygen

also by increasing enzymatic activity, which increases the rate of metabolic reactions and allows the processes of inflammation and healing to proceed more rapidly

Front 68

Is thermotherapy appropriate during the proliferative or remodeling stages, or when chronic inflammation is present?

Back 68

yes, as tolerated; but if it increases edema or inflammation, discontinue.

Front 69

How does increasing the temperature of blood aid healing?

Back 69

increasing the temperature of the blood increases the dissociation of oxygen from hemoglobin, making more oxygen available for the processes of tissue repair

Front 70

What may IR radiation be used for?

Back 70

treatment of psoriasis

Front 71

What should be included in patient instructions for use of thermotherapy (hot packs, paraffin, IR lamps) at home?

Back 71

- how to use the modality,
- location to apply,
- temperature to use,
- safety precautions,
- duration and frequency of treatment,
- how to identify possible adverse reactions

Front 72

Why is thermotherapy contraindicated in the case of recent or potential hemorrhage?

What should the therapist check for?

Back 72

heat causes vasodilation and increased blood flow, which could open/reopen a vascular lesion.

therapist should check for bruising/bleeding.

Front 73

For how long following bruising/bleeding/acute injury should thermotherapy be avoided?

Back 73

48 to 72 hours

Front 74

Why is thermotherapy contraindicated in the case of thrombophlebitis?

What should the therapist check for?

Back 74

the vasodilation and increased circulation could dislodge the clot

the therapist should ask if there is a clot in the area and check the calf for swelling and tenderness (Homan's sign) before applying heat

Front 75

Why is thermotherapy contraindicated in the case of impaired sensation or mentation?

What should the therapist check for?

Back 75

the patient's ability to understand and report discomfort are the primary indicators of maximum safe temperature

the therapist should ask if the patient has normal feeling in the treatment area and attempt to verify

note that sensation is often impaired in the distal extremities of patients with diabetes

Front 76

Is the lack of sensation in the treatment area an absolute contraindication for thermotherapy?

Back 76

no, it is possible to apply treatment proximally to increase peripheral circulation via the spinal cord reflex.

Front 77

What precautions should be used when treating patients with diabetes mellitus?

Back 77

they may have neuropathy and reduced sensation, along with diminished circulation in the extremities

Front 78

Why is thermotherapy contraindicated in the case of malignant tissue?

What should the therapist check for?

Back 78

thermotherapy may increase growth rate or rate of metastasis of malignant tissue, either by increasing circulation to the area or by increasing the metabolic rate

the therapist could ask if the patient is under a doctor's care for any major medical issues, has experienced unexplained weight loss, has a pain that does not change, or knows he/she has a tumor

Front 79

Why is thermotherapy applied with caution to areas of acute injury or inflammation?

What should the therapist check for?

Back 79

thermotherapy on an acute injury or inflammation could increase edema and bleeding due to vasodilation and increased blood flow

the therapist should inspect the skin for bruising and swelling, and ask when the injury occurred; assess color of skin and local edema

Front 80

What precautions should be undertaken in providing thermotherapy to a pregnant patient?

What should the therapist ask?

Back 80

since maternal hyperthermia could damage the fetus, avoid applying hot packs to the abdomen or lower back, or conducting any full-body heating (e.g., whirlpool)

the therapist should ask if the patient is pregnant, could be pregnant, or is trying to get pregnant

Front 81

What precautions should be undertaken in providing thermotherapy to patients with impaired circulation or poor thermal regulation?

Who is most at risk for these conditions?

What should the therapist do?

Back 81

if circulation is impaired, blood vessels may not vasodilate normally, or blood flow may not be sufficient to protect tissues from burns.

generally the risk is higher in the elderly and very young

the therapist should check skin temperature and quality and nail quality, and look for ulceration or swelling; milder heat should be used, and the patients should be checked more frequently

Front 82

What precautions should be undertaken in providing thermotherapy to a patient with edema?

What should the therapist do?

Back 82

thermotherapy can increase edema, so if heat is to be used, the limb should be elevated and heat applied with caution

the therapist should measure the limb to be treated and compare to the opposite, palpate for pitting/edema, and check for any other signs of inflammation

Front 83

What precautions should be undertaken in providing thermotherapy to a patient with cardiac insufficiency?

What should the therapist ask/check?

Back 83

heat-induced vasodilation can increase cardiac demand.

the therapist should ask if the patient has any heart problems, and if so, check heart rate and blood pressure before, during, and after treatment; monitoring is especially important if the treatment area is large

Front 84

What are normal, consensual cardiac responses to thermotherapy?

Back 84

slight decrease in blood pressure and increase in heart rate

Front 85

What precautions should be undertaken in providing thermotherapy to patients with metal in the area?

What should the therapist ask/check?

Back 85

as metal has a higher thermal conductivity, it can cause burns [this is more important with superficial metal (staples, pins, shrapnel) than with deeper metals (joint replacements)]

the therapist should check for and ask the patient to remove jewelry, and ask the patient if there is any metal in the area; the area could then be treated cautiously, with lower heat or more insulation and frequent checks for burning

Front 86

What precautions should be undertaken in providing thermotherapy to patients with open wounds?

What should the therapist ask/check?

Back 86

treat the area cautiously, as loss of epidermis reduces insulation; use a lower temperature or intensity, or more insulation and check the area more often for signs of burning

if the goal is increasing circulation and accelerating healing, hydrotherapy with clean, warm water can be used directly on the wound

other superficial agents should be used close to, but not directly on the wound to reduce the risk of contamination

Front 87

What precautions should be undertaken in providing thermotherapy to areas where topical counterirritants have been applied recently?

What should the therapist ask/check?

Back 87

if a thermal agent is applied to an area already vasodilated by a topical counterirritant, the vessels may not be able to vasodilate further to dissipate the heat and a burn may result

the therapist should ask if the patient applied any cream or ointment and if so, what type; if topical counterirritant was used, treatment should not proceed

Front 88

What precautions should be undertaken in providing thermotherapy to patients with demyelinated nerves?

What should the therapist ask/check?

Back 88

apply heat with caution, as demyelinated nerves are at risk for conduction blocks

the therapist should ask if patient has carpal tunnel syndrome or ulnar nerve entrapment

Front 89

What are the potential adverse effects of heat in general?
(Explain at least 4 adverse effects of thermotherapy.) ***

Back 89

- burns
- fainting (vasodilation can lower blood pressure)
- bleeding (primarily in patients with acute trauma or hemophilia)
- skin/eye damage from IR radiation

Front 90

Excessive heat can cause protein ________ and cell _______.

Back 90

denaturation (breakdown of proteins that permanently alters their biological activity)

death

Front 91

At what temperature does protein denaturation begin?

Back 91

45° C (113° F)

Front 92

At what times/temperatures does cell death begin?

Back 92

43° C (109° F) for 60 minutes or
46° C (115° F) for only 7 1/2 minutes

Front 93

How can overheating and tissue damage be avoided?

Back 93

- using superficial heating agents that cool during application,
- limiting the initial temperature of the agent, or
- using insulation between the agent and the patient's skin

Front 94

What is the most common cause of fainting?

Back 94

inadequate cerebral blood flow caused by peripheral vasodilation and decreased blood pressure, generally in association with a decreased heart rate

Front 95

What should the therapist do if the patient feels faint during thermotherapy?

Back 95

lower the head and raise the feet to bring more blood to the brain

Front 96

Why may a patient feel faint after thermotherapy?

Back 96

the heat is hypotensive, and the act of sitting up adds postural (orthostatic) hypotension to the mix

Front 97

Specifications for hot packs: ***

Back 97

- hydrocollator packs
- silicate gel (bentonite) that holds water well for moist heat
- unit kept at 70-75° C (158-167° F) (go with about 165°)
- treatment time: 20 minutes
- heat by conduction
- initial heating of the hot packs - 2 hours
- reheating of the hot packs - 30 minutes

Front 98

How many layers for hot packs?

Back 98

6 - 8 layers of dry towels
hot pack cover can substitute for 2-3 layers of towels

for us:
supine lower back: oversized hot pack with 1 hotpack cover under, 3 hotpack covers over, and a towel wrapped around the whole thing, mainly for sanitary reasons

prone lower back: oversized hot pack wrapped as above, except with 2 hotpack covers over instead of 3

pretty much all else: cervical hot pack in a cervical hot pack cover, with 4 layers of towel between it and patient

Front 99

What is a concern with a heavy (higher body fat) patient during thermotherapy?

Back 99

if the area treated has a high fat contact, the heat won't disperse as well (fat is less thermoconducive) and it may feel very hot to the patient at skin surface

Front 100

How should the hot pack wraps be adjusted if the hot pack is under the patient? On top of the patient?

Back 100

rule of thumb, if the patient is on top of the hot pack, use more layers as the table and the weight of the patient will slow heat loss

for us, one less hot pack cover if hot pack is on top of patient

Front 101

What should you do if the patient complains of feeling too much heat? Too little heat?

Back 101

add a layer of terry towel

if the patient complains of not feeling enough heat, use fewer layers NEXT treatment, as the increased skin temperature may decrease patient's thermal sensitivity and ability to safely judge tissue's heat tolerance.

Front 102

What should the therapist do after 5 minutes of thermotherapy?

Back 102

check the area for excessive redness, blistering, or other signs of burning

discontinue treatment and apply cold/ice pack if signs of burning to reduce inflammatory response

Front 103

How long is a typical hot pack treatment?

Back 103

20 minutes

Front 104

What should the therapist do at conclusion of thermotherapy?

Back 104

inspect skin for excessive redness, blistering, or other signs of burns

(also watch patient for signs of lightheadedness, especially if treatment area was large)

Front 105

Advantages of hot packs?

Back 105

- easy to use
- inexpensive materials (packs and towels)
- short use of clinician's time
- low level of skill needed for application
- can be used to cover moderate to large areas
- safe, because packs begin to cool immediately on removal from water
- readily available for patient purchase and home use

Front 106

Disadvantages of hot packs?

Back 106

- hot pack must be moved to observe the treatment area during treatment
- patient may not tolerate the weight of the hot pack
- pack may not be able to maintain good contact with small or contoured areas
- active motion is not practical during treatment
- moderately expensive equipment (hydrocollator)

Front 107

Specifics for paraffin: ***

Back 107

- paraffin:mineral oil ratio = 6:1 (or 7:1 says book)
- paraffin heater about 126-134° F (go with 130° F)
- Rx: Dip-and-wrap – 20 min
- Rx: Dip-immersion – 20 min (may need lower temperature)
- Rx: Brush on (with paintbrush) – 20 minutes
- heats by conduction

Front 108

Why is paraffin mixed with mineral oil?

Back 108

to lower the melting point from 54° C (129° F) to between
45-50° C (113-122° F)

Front 109

Paraffin can be applied safely to skin because of:

Back 109

its low specific heat and thermal conductivity

Front 110

The paraffin bath unit heats the paraffin to: ***

Back 110

52-57° C (126-134° F)
go with about 130° F (54° C)

Front 111

How do you convert Celsius to Fahrenheit? ***

Back 111

Tf = (9/5) * Tc+32

Front 112

How do you convert Fahrenheit to Celsius? ***

Back 112

Tc = (5/9) * (Tf - 32)

Front 113

Advantages of paraffin?

Back 113

- maintains good contact with highly contoured areas
- easy to use
- inexpensive
- body part can be elevated (dip & wrap or brush)
- oil lubricates and conditions skin
- can be used by patient at home

Front 114

Disadvantages of paraffin?

Back 114

- messy and time-consuming to apply
- cannot be used over open skin lesion as it may contaminate the lesion
- risk of cross-contamination if paraffin is reused
- part in dependent position for dip-immersion method

Front 115

Specifics for fluidotherapy: ***

Back 115

- cellulose particles from corn cobs
- cabinet with portals for extremities
- 38-48° C (100-118° F) (go with 117° F)
- Rx: 20 minutes
- heats by convection

Front 116

How does cryotherapy decrease blood flow? ***

Back 116

- decreases vasodilator (histamine and prostaglandin) release
- increases blood viscosity
- causes smooth muscle contraction
- affects spinal cord dorsal root ganglion
- causes vasoconstriction

Front 117

What are two categories of therapeutic heat? What are some examples of each? ***

Back 117

Thermotherapy and cryotherapy
- Thermo - hot pack, paraffin, fluidotherapy, ultrasound, diathermy
- Cryo - cold pack, ice pack, ice massage, controlled cold compression

Front 118

What are the five types of heat exchange utilized with application of heat/cold modalities? ***

Back 118

- conduction
- convection
- conversion
- radiation
- evaporation

Front 119

Explain at least 6 physiologic effects of heat application. ***

Back 119

- vasodilation,
- nerve conduction velocity increases,
- pain threshold increases,
- changes in muscle strength,
- metabolic rate increases,
- tissue extensibility increases

Front 120

Explain at least four uses (indications) of treatment with therapeutic heat. ***

Back 120

- pain control,
- increase ROM,
- decrease stiffness,
- accelerate healing,
- increasing oxygen to tissue

Front 121

Explain at least seven physiological effects with general application of cold and how this benefits the patient. ***

Back 121

- initial vasoconstriction (reduces flow, inflammation)
- delayed vasodilation (potential rebound increase metabolism/oxygen)
- increased blood viscosity (reduces flow)
- nerve conduction velocity decreased (mostly a-delta fibers)
- pain threshold increased (probably gating mechanism)
- muscle strength altered (after 5 mins increase, after 30 mins decrease, then increase)
- spasticity decreased
- facilitation of flaccid muscle
- metabolic rate decreased

Front 122

How is cryotherapy primarily used outside of rehabilitation?

Back 122

for destruction of malignant and nonmalignant tissue growths

Front 123

What type of cooling does rehabilitation/physical therapy use?

Back 123

mild cooling

Front 124

For what is cryotherapy used (indications)? ***

Back 124

- control inflammation
- reduce pain
- control edema
- reduce spasticity
- control symptoms of multiple sclerosis
- facilitate movement

Front 125

How does cryotherapy exert its therapeutic effects?

Back 125

by influencing hemodynamic, neuromuscular, and metabolic processes

Front 126

What hemodynamic effects does application of cryotherapy have?

Back 126

initial decrease in blood flow, followed by a later increase in blood flow

Front 127

When cold is applied to the skin, it causes an immediate ______ of the cutaneous vessels and a ______ in blood flow.

Back 127

vasoconstriction
reduction

Front 128

For how long will vasoconstriction persist with cold application?

Back 128

it will persist as long as the cold application is limited to 15-20 minutes or less

Front 129

How can vasoconstriction be induced even more effectively with cold?

Back 129

use an initial 20-minute application, then two cycles on/off for 10 minutes each (this cools more effectively than a second 20-minute session)

Front 130

Where is the vasoconstriction and reduction in blood flow produced by cryotherapy most pronounced?

Back 130

in the area of application, because this is where the tissue temperature decrease is greatest. (Not as pronounced of a "traveling effect" as with thermotherapy)

Front 131

Cold causes cutaneous vasoconstriction both directly and ______.

Back 131

indirectly

Front 132

Cold application causes cutaneous vasoconstriction directly through what mechanisms?

Back 132

through activation of the cutaneous cold receptors, which stimulate contraction of the smooth muscles lining blood vessels

Front 133

Cold application causes cutaneous vasoconstriction indirectly through what mechanisms?

Back 133

- it reduces vasodilator (histamine and prostaglandin) release, and
- it causes a reflex activation of sympathetic adrenergic neurons which, in turn, cause vasoconstriction in the cooled area and to a lesser extent in areas distant to the site of application

Front 134

Why is it thought the body reduces blood flow in response to decreased tissue temperature?

Back 134

to protect other areas from excessive decreases in temperature and stabilize the core body temperature--the less blood flowing through a cooled area, the smaller amount of blood that is cooled and less other areas are affected

Front 135

Why does reduced circulation result in a greater decrease in temperature of area to which a cooling agent is applied?

Back 135

less circulating, warm blood is brought into the area to raise the temperature by convection

Front 136

Why does reduced circulation result in a lesser decrease in temperature of the rest of the body when a cooling agent is applied?

Back 136

the colder blood tends to remain in the cooled area, and not circulate to cool the rest of the body

Front 137

What causes cold-induced vasodilation (CIVD) or the "hunting response"?

Back 137

cold applied for longer period of time (> 15 minutes) or tissue temperature reduced to less than 10° C (50° F) may induce vasodilation (but it's not a given in everyone)

Front 138

Who first reported CIVD, and when?

Back 138

Lewis in 1930

Front 139

Is vasodilation a consistent response to prolonged cold application?

Back 139

no, therefore it should not be counted on in selecting a treatment modality

Front 140

What did Lewis find with application of cold?

Back 140

after 15 minutes, patient's temperature began to cyclically increase and decrease

Front 141

What is the "hunting response"?

Back 141

the cyclic increase and decrease in temperature/alternating vasoconstriction and vasodilation associated with application of cold for more than 15 minutes

Front 142

It is proposed that the hunting response is mediated by:

Back 142

an axon reflex in response to the pain of prolonged cold or very low temperatures; or that it is caused by inhibition of contraction of the smooth muscles of the blood vessel walls by extreme cold

Front 143

Where is CIVD most likely to occur?

Back 143

in the distal extremities

Front 144

Under what situations may CIVD (without cycling) be induced?

Back 144

application of cold for more than 15 minutes at temperatures below 1° C

Front 145

To what is the increase in skin redness with cold application attributed?

Back 145

it is likely not CIVD, but is actually thought to be primarily the result of an increase in the oxyhemoglobin concentration of the blood as a result of the decrease in oxygen-hemoglobin dissociation that occurs at lower temperatures

Front 146

Is CIVD an effective means of increasing oxygen delivery to an area?

Back 146

no, because cooling decreases oxygen-hemoglobin dissociation, making less oxygen available to the tissues

Front 147

What neuromuscular effects does cryotherapy have? ***

Back 147

- decreased nerve conduction velocity (mostly a-delta fibers)
- increased pain threshold (probably gating mechanism)
- altered muscle strength
- decreased spasticity
- facilitation of muscle contraction

Front 148

How long does it take application of cryotherapy to induce reduction in nerve conduction velocity?

Back 148

5 minutes or more

Front 149

How long does it take to reverse reduction in nerve conduction velocity with 5 minutes of cooling? With 20 minutes?

Back 149

15 minutes
30 minutes or longer

Front 150

What types of nerves can cold decrease conduction velocity of?

Back 150

sensory and motor

Front 151

On which nerves does cold have the greatest effect?

Back 151

cold has the greatest effect on conduction by myelinated and small fibers and the least effect on conduction by unmyelinated and large fibers

Front 152

What are A-delta fibers and how are they affected by cold?

Back 152

A-delta fibers, which are small-diameter, myelinated, pain-transmitting fibers, demonstrate the greatest decrease in conduction velocity in response to cooling

Front 153

Is total nerve conduction block reversible?

Back 153

yes

Front 154

How can total nerve conduction block occur with application of cold?

Back 154

reversible total nerve conduction block can occur with application of ice over superficially located major nerve branches (e.g., peroneal nerve at lateral aspect of the knee)

Front 155

What is the proposed mechanism for the decreased sensation of pain/increased pain threshold with the application of cold?

Back 155

counter-irritation via the gate control mechanism, thereby blocking transmission of painful stimuli to the brain cortex; and the reduction of muscle spasm, sensory nerve conduction velocity, or post-injury edema

Front 156

Gating of the sensation of pain can also reduce:

Back 156

muscle spasm by interrupting the pain-spasm-pain cycle

Front 157

How may cryotherapy help reduce pain of an acute injury?

Back 157

by reducing the rate of blood flow in an area and by decreasing the rate of reactions related to acute inflammation, thus controlling post-injury edema formation

Front 158

How does reducing edema reduce pain?

Back 158

it reduces compression of nerves and other sensitive structures

Front 159

Is cryotherapy associated with increases or decreases in muscle strength?

Back 159

both, depending on duration of treatment and time of measurement

Front 160

When is muscle strength increased by cryotherapy? ***

Back 160

after 5 minutes or less of application (it is not known, however, how long this effect lasts)

Front 161

What happens to isometric muscle strength following cooling of 30 minutes or longer? ***

Back 161

initially it decreases, then begins to increase after about an hour

Front 162

What are the proposed mechanisms for increased strength after brief (5 minutes or less) cooling?

Back 162

facilitation of motor nerve excitability and an increased psychological motivation to perform

Front 163

How long-lasting is the effect of increased muscle strength with cooling of 30 minutes or more? ***

Back 163

following the initial decrease (up to an hour afterward) the increase exceeds the precooling strength (at about 90 minutes) and this effect lasts 3 hours or more

Front 164

What must the therapist consider when wishing to gauge muscle strength in a patient undergoing cryotherapy?

Back 164

since the muscle strength is temporarily altered by cooling, test the patient before the cryotherapy application.

Front 165

What are the proposed mechanisms for reduced strength after prolonged cooling?

Back 165

- reduction of blood flow to the muscles
- slowed motor nerve conduction
- increased muscle viscosity
- increased joint or soft tissue stiffness

Front 166

What mechanisms are thought to decrease spasticity with cryotherapy?

Back 166

- decrease in gamma motor neuron activity initially, then
- a decrease in afferent spindle and Golgi tendon organ (GTO) activity

Front 167

After prolonged cooling (10-30 minutes) how is spasticity affected?

Back 167

it is temporarily decreased or eliminated

Front 168

How long-lasting are the effects of decreased or eliminated spasticity due to prolonged (10-30 minutes) cooling?

Back 168

1 to 1 1/2 hours

Front 169

How can the decrease or elimination of spasticity following prolonged (10-30 minutes) cooling be taken advantage of?

Back 169

apply the cooling to hypertonic areas before other interventions to reduce spasticity during functional or therapeutic activities

Front 170

How can cryotherapy be useful in treating flaccid muscles?

Back 170

brief application of cryotherapy is thought to facilitate alpha motor neuron activity to produce contraction in flaccid muscle (not often used)

Front 171

How long are flaccid muscles cooled to induce contraction?

Back 171

A few seconds (and the effect is short-lived)

Front 172

What happens to muscle contractions with prolonged cooling of even a few minutes?

Back 172

a decrease in gamma motor neuron activity reduces the force of muscle contractions

Front 173

Cold _______ the rate of all metabolic reactions.

Back 173

decreases

Front 174

Cold decreases the rate of all metabolic reactions, including those involved in _____ and _____

Back 174

inflammation and healing

Front 175

Can application of cold delay healing?

Back 175

yes

Front 176

How is cryotherapy useful for treatment of RA and other inflammatory joint diseases?

Back 176

it inhibits activity of cartilage-degrading enzymes, including collagenase, elastase, hyaluronidase, and protease, almost completely stopping them at joint temperatures of 30° C (86° F)
(pg. 137)

Front 177

When should cold be used to control acute inflammation and accelerate recovery?

Back 177

The first 48 (to 72) hours

Front 178

How does cryotherapy help in healing of acute inflammation?

Back 178

cold slows the rate of the chemical reactions that occur during the acute inflammatory response, and also reduces the heat, redness, edema, pain, and loss of function associated with this phase of healing

Front 179

How does cryotherapy affect fluid movement in cases of acute inflammation? ***

Back 179

blood flow is decreased by vasoconstriction and increased blood viscosity

decreased capillary permeability impedes movement of fluid from capillaries to interstitial tissue, thereby controlling bleeding and fluid loss after acute trauma

Front 180

It is also thought that cryotherapy partially prevents microvascular damage by:

Back 180

decreasing activity of leukocytes, which damage vessel walls and increase capillary permeability

Front 181

How can one estimate the stage of healing for an acute injury?

Back 181

by local skin temperature; if the skin is still warm, it's probably still inflamed and cryotherapy can help

Front 182

How long does it normally take for acute inflammation to resolve?

Back 182

48 to 72 hours

Front 183

When may inflammation be prolonged?

Back 183

- with severe trauma
- with inflammatory diseases like RA
- with chronic, recurrent injuries

Front 184

What should the therapist consider if the temperature of an area remains elevated for longer than expected? What should he/she do?

Back 184

infection

patient should be referred to a physician for further evaluation

Front 185

Why should cryotherapy be discontinued when the acute inflammation has resolved?

Back 185

to avoid impeding recovery by slowing chemical reactions (metabolism/oxygenation) or impairing circulation

Front 186

When is continuous, low-level cryotherapy potentially useful?

Back 186

to reduce pain and inflammation for several days after orthopedic surgery (hip replacement, shoulder surgery, etc.) but although evidence in favor of this is mounting, it's not commonly used

Front 187

What can cryotherapy do for Delayed-onset Muscle Soreness (DOMS)?

Back 187

it can be used prophylactically after exercise to reduce severity of DOMS (b/c it's due to inflammation of muscle and connective tissue)

Front 188

When cryotherapy is applied with the goal of controlling inflammation, the treatment time is generally limited to ______ because______

Back 188

15 minutes or less
because longer application has been associated with vasodilation and increased circulation

Front 189

Has reflex vasodilation been shown to occur outside distal extremities?

Back 189

no, so treatments longer than 15 minutes may be used for areas other than distal extremities

Front 190

To limit probability of excessive decreases in tissue temperature and cold-induced injury, cryotherapy applications should be:

Back 190

at least 1 hour apart so that the tissue temperature can return to normal between treatments

for distal extremities, limit treatment to 20-minute treatments (or shorter) at least 1 hour apart

Front 191

During acute inflammation, edema is caused by:

Back 191

extravasation of fluid into the interstitial tissues as a result of increased intravascular fluid pressure and increased vascular permeability

Front 192

Cryotherapy reduces intravascular fluid pressure by:

Back 192

reducing blood flow into the area via vasoconstriction and increased blood viscosity

Front 193

Cryotherapy also controls increases in capillary permeability by: ***

Back 193

reducing the release of vasoactive substances such as histamine

Front 194

To minimize edema formation, cryotherapy should be applied:

Back 194

as soon as possible after an acute trauma

Front 195

How is edema associated with inflammation most effectively controlled?

Back 195

Rest
Ice
Compression
Elevation

Front 196

Compression and elevation reduce edema by driving extravascular fluid out of the swollen area and into:

Back 196

the venous and lymphatic drainage systems

Front 197

Is cryotherapy effective in reducing edema associated with immobility and poor circulation?

Back 197

No

Front 198

How is edema associated with immobility and poor circulation best handled?

Back 198

increased venous or lymphatic circulation is required and this is best accomplished with compression, elevation, heat, exercise, and massage

Front 199

The analgesic effect of cold is exploited when used to cool the skin before _____

Back 199

stretching the muscles below;

the reduced sensation of pain allows the stretch to be more forceful and potentially more effective

Front 200

Applying cryotherapy for 10-15 minutes or longer can control pain for _____

Back 200

1 or more hours because the temperature of the area remains lower than normal for 1-2 hours after removal of the treatment

Front 201

Reduction of pain by cryotherapy can also interrupt: ***

Back 201

the pain-spasm-pain cycle (even after the temperature of the area returns to normal)

Front 202

To reduce spasticity in patients with upper motor neuron dysfunctions, cryotherapy can be applied for up to

Back 202

30 minutes

Front 203

What patients in particular benefit from cold over heat?

Back 203

MS patients, whose symptoms are often aggravated by heat

Front 204

Cooling an MS patient with a vest has been shown to:

Back 204

improve fatigue, muscle strength, visual function, and postural stability

Front 205

Peripheral cooling has been found to decrease _____ in MS patients.

Back 205

tremor

Front 206

What is quick icing?

Back 206

rapid application of ice as a stimulus to elicit desired motor patterns in patients with flaccidity resulting from upper motor neuron dysfunction

Front 207

Who developed the technique of quick icing?

Back 207

Rood

Front 208

Is quick icing often used?

Back 208

no, as its results are unreliable and may actually cause a rebound movement opposite of the desired direction

Front 209

What is cryokinetics?

Back 209

combined use of cold and exercise to treat a pathology or disease

Front 210

Who is the primary patient for cryokinetics?

Back 210

athletes in rehabilitiation

Front 211

How is cryokinetics administered?

Back 211

cold is applied to area for 20 minutes or until numb;
patient performs stretching and strengthening exercises for 3-5 minutes until sensation returns;
area is recooled to numbness; and
this is repeated about 5 times

Front 212

What is important to know prior to utilizing cryokinetics?

Back 212

The exact nature of the injury to avoid further trauma and tissue damage

Front 213

What is cryostretch?

Back 213

the application of a cooling agent before stretching to reduce muscle spasm and improve range of motion

Front 214

What are the contraindications for cryotherapy? ***

Back 214

- hypersensitivity or intolerance (may develop urticaria, severe pain, numbness, tingling)
- cryoglobulinemia (proteins aggregate in distal extremity, impair circulation, cause ischemia--rare)
- paroxysmal cold hemoglobinuria (blood in urine following exposure to cold--rare)
- Raynaud’s disease/phenomenon (disease-symptoms bilateral no matter what's treated; phenomenon-affected extremity only)
- over regenerating nerves (may delay regeneration)
- peripheral vascular disease (vasoconstriction may aggravate--circulation already decreased)

Front 215

Contrast edema from inflammation with edema from poor circulation.

Back 215

poor circulation - area is cool and pale (don't use cold)
inflammation - area is warm and red (can benefit from cold)

Front 216

What are the precautions for the use of cryotherapy? ***

Back 216

over superficial main nerve branch (may cause conduction block)
over deep open wound (can delay healing)
hypertension (can cause transient increases in BP--monitor during treatment)
poor sensation
poor mentation
very old or very young (impaired thermal regulation and limited ability to communicate)

Front 217

What are some of the adverse effects of cryotherapy? ***

Back 217

Frostbite; tissue death
Nerve damage (temporary or permanent)
Unwanted vasodilation

Front 218

At what temperature can tissue damage occur? Frostbite?

Back 218

15° C (59° F)
-4° to -10° C (39° to 14° F)

Front 219

What is the maximum cryotherapy treatment time and minimum temperature to avoid soft tissue or nerve damage?

Back 219

under 45 minutes
keep temperature above 15° C (59° F)

Front 220

What is the maximum application time for cryotherapy to the distal extremities to produce vasoconstriction?

Back 220

10 to 20 minutes
(we're using 10-15)

Front 221

Specifications for a cold pack:

Back 221

Vinyl pack filled with silica
Stored in freezer -5° C (23° F)
Rx: wrap cold pack with towel (wet with warm water)
10-15 min. usual time
spasticity - about 30 min. (check every 10-15 minutes for adverse effects)

Front 222

Cryotherapy options:

Back 222

cold pack/ice pack
ice cup/ice massage
controlled cold compression
vapocoolant spray
frozen towels
ice water
cold whirlpool
contrast bath

Front 223

Length of time to cool a cold pack:

Back 223

2 hours before initial use,
30 minutes between uses

Front 224

In general, how deep is the cooling of frozen gel packs or ice packs after 20 minutes?

Back 224

up to 2 cm

Front 225

What is the sequence of sensations associated with cryotherapy? ***

Back 225

1) intense cold
2) burning
3) aching
4) analgesia
5) numbness

Front 226

Ice pack specifications: ***

Back 226

Plastic bag filled with water and ice - add a little alcohol
Or, use 4:1 ratio water:alcohol and place in freezer
Stored in freezer -5° C (23° F)
Rx: wrap cold pack with towel (wet with warm water)
10-15 min. usual time
spasticity - about 30 min. (check every 10-15 minutes for adverse effects)

Front 227

Ice packs are more aggressive cooling agents than cold/gel packs because:

Back 227

ice has a higher specific heat than most gels and ice absorbs a large amount of energy when it melts and changes from a solid to a liquid

Front 228

Which requires more insulation, a cold/gel pack or ice pack?

Back 228

ice pack, because it provides more aggressive cooling

Front 229

When wrapping a cold/ice pack in a wet towel, what temperature water should be used to wet the towel? Why?

Back 229

use warm water
to allow the patient to gradually become used to the cold

Front 230

What is a rule of thumb for use of wet/dry towel for cold or ice packs?

Back 230

thin, dry towel for slower, less intense cooling and to slow more intense cooling of ice pack

wet towel is more appropriate for a cold pack
dry towel for ice pack

Front 231

Advantages of cold/ice packs:

Back 231

- easy to use
- inexpensive materials and equipment
- short use of clinician's time
- low level of skill required for application
- covers moderate to large areas
- can be applied to elevated limb

Front 232

Disadvantages of cold/ice packs:

Back 232

- pack must be removed to visualize treatment area during treatment
- patient may not tolerate weight of pack
- pack may not be able to maintain good contact on small or contoured areas
- long duration of treatment compared to massage with an ice cup

Front 233

Ice pack vs. cold pack:

Back 233

- ice pack provides more intense cooling
- ice pack is less expensive
- cold pack is quicker to apply

Front 234

Advantages of ice massage:

Back 234

- treatment area can be observed during treatment
- can be used for small/irregular areas
- short duration of treatment
- inexpensive
- can be applied to elevated limb

Front 235

Disadvantages of ice massage:

Back 235

- too time-consuming for large areas
- requires active participation by clinician or patient throughout application

Front 236

Specifications for contrast bath: ***

Back 236

Cold water at 10-18° C (50-64° F) (go with 60° F)
Warm water 38 – 44° C (100-111° F) (go with 110° F)
Alternate baths 4 min. warm, then 1 min. cold.
Continue sequence of warm-cold 1 min. each until 20-30 min. elapse
end on warm, unless patient suffering from edema

Front 237

Sequelae of injury depend on:

Back 237

- source and site of injury
- state of local homeostasis
- whether injury is acute or chronic

Front 238

Ultimate goal of inflammation and repair is to restore function by:

Back 238

- eliminating the pathological or physical insult
- replacing damaged tissue
- promoting regeneration of tissue structure

Front 239

Three phases of inflammation and repair:

Back 239

1) inflammation phase - prepares the wound for healing
2) proliferation phase - rebuilds the damaged structures and strengthens the wound
3) maturation phase - modifies the scar tissue into its mature form

Front 240

Can healing occur without inflammation?

Back 240

No

Front 241

Inflammation is an immediate ______

Back 241

protective response

Front 242

What are the five cardinal signs of inflammation? ***

(Cornelius Celsus - 4
Virchow - 1)

Back 242

heat (calor - increased vascularity)
redness (rubor - increased vascularity)
swelling (tumor - blockage of lymphatic drainage)
pain (dolor - physical pressure on or chemical irritation of pain-sensitive structures)
Loss of function (Functio laesa - pain and swelling)

Front 243

What is hyperemia?

Back 243

increase in blood in a given area

Front 244

From what does local swelling originate at the site of acute inflammation?

Back 244

increased permeability and vasodilation of local blood vessels and infiltration of fluid into the interstitial spaces of the injured area

Front 245

Stages of tissue repair: ***

Back 245

Inflammation Phase- (1-6 days) = Acute

Proliferation Phase- (3-20 days) = Sub-acute; Repair

Maturation Phase- (9 days onward--could last a year or longer) = Chronic; Remodeling

Front 246

Causes of inflammation ***

Back 246

- Foreign substances
- Allergens/Autoimmunity
- Chemical agents (poisons, toxins, venoms)
- Trauma
- Pathogenic agents (bacteria, viruses, fungi, parasites)
- Physical agents (radiation, temperature extremes)

Hint 246

FACTPP

Front 247

What characterizes the inflammation phase? ***

Back 247

- vascular response - initial vasoconstriction, then vasodilation

- hemostatic response - clot formation

- cellular response - WBCs (macrophage phagocytosis; sends signal to attract fibroblasts and alerts immune system); RBCs (minor role of oxygen),

Front 248

What characterizes the proliferation phase? ***

Back 248

- epithelialization - re-establishment of epidermis, or serous and mucous membranes (a barrier is formed to protect the wound)

- collagen production [fibroblasts (precursors to collagen) migrate to area]

- wound contracture

- neovascularization - angiogenesis (new blood vessels)

Front 249

What is wound contraction? ***

Back 249

pulling together the edges of the wound

Front 250

What is healing by primary intention? ***

Back 250

stitches
(healing without wound contraction)

Front 251

What is healing by secondary intention? ***

Back 251

wound is left open to heal on its own (e.g., abscess)

Front 252

What occurs during the maturation phase? ***

Back 252

- balance of collagen synthesis and lysis
- too much synthesis can produce keloids (scars that invade surrounding tissue) or hypertrophic scars (raised, but within margin of original wound

- collagen matures, vascularity decreases, scar whitens

Front 253

What is chronic inflammation? ***

Back 253

- follows acute inflammation
- persists due to continued trauma or another inhibitor of healing

(e.g., response to foreign material like an implant, or autoimmune disease)

Front 254

What two types of factors affect healing? ***

Back 254

- local factors
- systemic factors

Front 255

What local factors affect healing? ***

Back 255

- type, size, location of injury
- infection
- vascular supply
- external forces (temperature deviation, topical medications, electromagnetic energy)
- movement/excessive pressure
- retained foreign body

Front 256

What systemic factors affect healing? ***

Back 256

- age
- disease
- medications
- metabolic status
- nutrition
- hormones
- fever
- oxygen

Front 257

What interventions are acceptable during the inflammation phase? ***

Back 257

passive movement

protective phase--body is preparing wound for healing

Front 258

What interventions are acceptable during the repair/proliferation phase? ***

Back 258

controlled motion

non-destructive active and some resistive movement

Front 259

What interventions are acceptable during the maturation phase? ***

Back 259

return to normal function

Front 260

How may heat be transferred with respect to the body?

Back 260

into, away from, or within

Front 261

How is heat transferred within the body by conduction?

Back 261

one area of the body is heated by an external thermal agent, and the adjacent tissues increase in temperature

Front 262

What is diathermy?

Back 262

an electromagnetic form of energy that, when applied to the body, causes rotation of polar molecules, resulting in friction and increase in tissue temperature

Front 263

What are some of the effects of heat application (thermotherapy) on the body? ***

Back 263

- vasodilation (at the site and distally)
- increased nerve conduction velocity/firing rate
- pain threshold increased
- changes in muscle strength/endurance
- increased metabolic rate
- increased tissue extensibility

Front 264

Cutaneous vasodilation and the increase in blood flow that occurs in response to increased tissue temperature act to:

Back 264

protect the body from excessive heating and tissue damage

Front 265

How does vasodilation protect the cutaneous layers from tissue damage?

Back 265

the increased blood flow increases cooling by convection; cooler blood is continuously pumped into the area where it takes heat away as it returns to the heart

Front 266

Could you use fluidotherapy on a patient with an open wound?

Back 266

you could treat if there was a way to cover the injury, such as using a glove

Front 267

What is another contraindication specifically for fluidotherapy, over and above the contraindications for heat?

Back 267

if the patient has a corn allergy

Front 268

What are the advantages of fluidotherapy?

Back 268

- patient can move during the intervention to work on gaining ROM
- minimal pressure is applied to the area being treated
- temperature is well-controlled and constant throughout treatment
- easy to administer
- short use of clinician's time

Front 269

What are the disadvantages of fluidotherapy?

Back 269

- expensive equipment
- limb must be in dependent position in some units, increasing risk of edema
- constant heat source may result in overheating
- if corn cob particles spill onto smooth floor, they make it very slippery

Front 270

How long can the analgesic effects of cryotherapy potentially last? Why?

Back 270

1 hour or more after a 10-15 minute treatment

blocking of deep pain-transmitting A-delta fibers and gating of pain transmission is prolonged because the temperature of the treated area remains lower than normal for 1-2 hours after treatment;

rewarming is slowed by cold-induced vasoconstriction preventing flow of warm blood into the area and subcutaneous fat slows rewarming by conduction from the ambient air

Front 271

With what afflictions may cryoglobulinemia be associated?

Back 271

- multiple myeloma
- systemic lupus erythematosus
- rheumatoid arthritis
- other hyperglobulinemic states

Front 272

With what afflictions may Raynaud's disease or phenomenon be associated?

Back 272

- thoracic outlet syndrome
- carpal tunnel syndrome

Front 273

Why does applying cryotherapy over an area of superficial skin damage result in less-pronounced responses?

Back 273

while cryotherapy can be used over areas of superficial (not deep) tissue damage, the thermal receptors which play a large part in activating the vasoconstriction, pain control, and spasticity reduction may be damaged or absent, resulting in a less-desirable outcome

also, absence of skin could result in excessive cooling of these tissues; use less-intense cooling

Front 274

What is the Game Ready used for? ***

Back 274

controlled cold compression

Front 275

What are the types of vapocoolant sprays? ***

Back 275

- ethyl chloride (which is volatile and flammable)
- fluori-methane (which was volatile and a CFC/ozone layer depleter--now discontinued)
- Gebauer's ethyl chloride (not flammable or ozone-depleting) sold as:

-Spray and Stretch
- Instant Ice, and
- Pain Ease

Front 276

Who devised the spray and stretch treatment for trigger points?

Back 276

Janet Travell

Front 277

How is pain defined? ***

Back 277

unpleasant sensory AND EMOTIONAL experience

associated with actual or potential tissue damage, or described in terms of such damage

Front 278

What are some factors that influence pain? ***

Back 278

- focus of attention (you're thinking about it)
- level of anxiety
- degree of suggestibility
- level of arousal/cognitive awareness
- degree of fatigue
- previous emotional and psychological experience
- cultural mores

Front 279

List three different pain theories. ***

Back 279

- Specificity Theory
- Pattern Theory
- Gate Control Theory

Front 280

What does the Specificity Theory of pain state? ***

Back 280

pain is the response to stimulation of "specific" pain receptors

sensory impulses travel along specific sensory fibers
pain impulses travel along specific pain fibers

(uses separate sensors for pain and heat)

Front 281

What does the Pattern Theory of pain state? ***

Back 281

quality of sensation depends on intensity or frequency of impulses

Front 282

How does the Gate Control Theory describe pain? ***

Back 282

a control mechanism (gate) exists in the spinal cord

- greater input from A-beta fibers closes the gate and reduces or eliminates pain

- greater input from A-delta or C fibers opens the gate and increases pain

Front 283

What are the components of the Neurochemical Theory of Pain Control? ***

Back 283

neurochemicals - endogenous opiates produced in brain and glands, released to counter pain

- enkephalins - 2-minute half life
- endorphins - (opiopeptins) 4-hour half life
dynorphins, serotonin, dopamine

Front 284

Name three types of pain. ***

Back 284

- acute
- chronic
- referred

Front 285

How is acute pain characterized? ***

Back 285

pain of recent and sudden onset

with demonstrable etiology and limited course

Front 286

How is chronic pain characterized? ***

Back 286

pain that no longer signals real or impending tissue damage

- does not resolve in the usual time it takes for the disorder to heal, or
- continues beyond the duration of noxious (harmful) stimulation

often has a psychological component (depression, attention-seeking, hypochondria)

Front 287

How is referred pain characterized? ***

Back 287

pain felt at a location distant from its source

(e.g., pain in jaw during a heart attack)

Front 288

What is a trigger point? ***

Back 288

a small, hypersensitive area in the muscle or fascia

when pressure is applied to it, it can produce pain at the site, or at a referred site

Front 289

What is analgesia? ***

Back 289

absence of pain on noxious stimulation

Front 290

What is causalgia? ***

Back 290

intense, burning pain accompanied by trophic skin changes due to injury of nerve fiber

Front 291

What is neuralgia? ***

Back 291

pain occurring along the course of a nerve

Front 292

What is hyperalgesia? ***

Back 292

increased sensitivity to noxious (harmful) stimulation

Front 293

What is hypoalgesia? ***

Back 293

decreased sensitivity to noxious (harmful) stimulation

Front 294

What is allodynia? ***

Back 294

painful response to a normally non-painful stimulus

Front 295

What is the pain perception threshold? ***

Back 295

the least intensity of noxious (harmful) stimulation at which a person perceives pain

fairly constant from person to person

Front 296

What is pain tolerance? ***

Back 296

the greatest intensity of noxious (harmful) stimulation an individual can bear

varies greatly from person to person

Front 297

Which is fairly constant from person to person: ***

pain perception threshold
pain tolerance level

Back 297

pain perception threshold

Front 298

Which varies greatly from person to person: ***

pain perception threshold
pain tolerance level

Back 298

pain tolerance level

Front 299

What is the pain pathway? ***

Back 299

from the
- nociceptor to the
- A-delta and C fibers, to the
- dorsal horn of the spinal column, to the
- spinothalamic tracts, to the
- thalamus, to the
- cortex

Front 300

What is a nociceptor? ***

Back 300

a sensory receptor (from the L. nocere--to injure)

in most tissue (except nucleus pulposus and inner part of annulus fibrosus)

activated by intense thermal, chemical, and/or mechanical stimuli

Front 301

What are C fibers? ***

Back 301

small, unmyelinated fibers

transmit signal slowly (1-4 m/sec); long-lasting pain (emotionally difficult, diffuse)

dull, throbbing, aching--noxious
(may also be reported as tingling, tapping, etc.)
(see p. 54)

Front 302

What are A-delta fibers? ***

Back 302

small, myelinated nerves

transmit signals quickly (5-30 m/sec); localized

sensation sharp, stabbing, pricking

quick onset, short lasting, not generally emotionally involved

Front 303

What is the dorsal horn? ***

Back 303

gray matter of the spinal cord

lateral spinothalamic tract - transmits sharp pain, localized (A-delta fiber)

anterospinothalamic tract - transmission of more prolonged, aching pain, involve disturbing emotions (C fiber)

Front 304

What are the first-order neurons? ***

Back 304

C fibers
A-delta fibers

to dorsal horn

Front 305

What are the second-order neurons? ***

Back 305

dorsal horn to thalamus

Front 306

To where do the C fibers and A-delta fibers transmit pain signals? ***

Back 306

to the dorsal horn

Front 307

To where does the dorsal horn direct pain signals received from the C fibers and A-delta fibers? ***

Back 307

to the thalamus

(where the second-order neurons terminate)

Front 308

What does the thalamus do with the pain signals it receives? ***

Back 308

interprets the information and redirects it to the cortex

Front 309

Where do third-order neurons terminate? ***

Back 309

in the cortex

Front 310

What happens to pain signals in the cortex? ***

Back 310

they reach into the consciousness

Front 311

What is substance P? ***

Back 311

a neurotransmitter thought to be involved in transmission of pain

released from nociceptors, triggering action potential

also found in CNS
(persons with elevated levels of substance P often have signs of depression as well)

Front 312

List some methods of measuring pain: ***

Back 312

- Keele's Scale
- Visual Analog Scale (VAS)
- McGill Pain Questionnaire

Front 313

How does Keele's Scale measure pain? ***

Back 313

mild, moderate, severe

Front 314

How does the Visual Analog Scale measure pain? ***

Back 314

on a line or on a scale of 1-10
(faces for children)

("no pain" to "worst pain possible")
good for quick estimate of pain severity

Front 315

How does the McGill Pain Questionnaire measure pain? ***

Back 315

uses adjectives in columns to collectively describe the pain sensation

a.k.a. semantic differential scale

Front 316

How are body diagrams used to describe pain? ***

Back 316

various markings are made on a drawing of the body to describe the pain type and location

Front 317

What are some pharmacological approaches to pain control? ***

Back 317

NSAIDs
Acetaminophen
opiates
antidepressants
spinal analgesia
local injection

Front 318

What are some available NSAIDs and their side effects? ***

Back 318

- aspirin
- ibuprofen
- naproxen sodium
- piroxicam (Feldene)
- Celebrex (1999)
- Vioxx (1999-2004, withdrawn)

side effects include:
GI irritation, prolonged bleeding, kidney damage

Front 319

What is the primary side effect of acetaminophen (Tylenol)? ***

Back 319

liver damage

Front 320

Name some opiates available for pain control and list their side effects. ***

Back 320

- morphine
- codeine
- hydrocodone
- fentanyl
- methadone

side effects include:
nausea, vomiting, sedation, cough suppression, slowed respiration, possible addiction

Front 321

How are antidepressants used in pain management? ***

Back 321

chiefly for chronic pain

Front 322

What injection methods are available for inducing spinal analgesia? ***

Back 322

- anesthetics,
- corticosteroids, or
- opiates

injected into the epidural or subarachnoid space

Front 323

What injection methods are available for localized pain control? ***

Back 323

- anesthetics,
- corticosteroids, or
- opiates

injected into joints, bursae, trigger points

Front 324

Who is involved in a multidisciplinary approach to pain treatment? ***

Back 324

- physical therapy
- physician
- psychologist

Front 325

Steps in the inflammation phase, according to the chart on page 26:

Back 325

- vasoconstriction (caused by norepinephrine; lasts for the first 5-10 minutes post injury)
- vasodilation (caused mainly by histamine; of non-injured vessels for up to 1 hour post injury)
- clot formation (platelets bind to exposed collagen, release fibrin, create fibrin lattice to confine area; chemotactic signaling of fibroblasts)
- phagocytosis (neutrophils first for 24 hours; monocytes 24-48 hrs, convert into macrophages, remove damaged tissue & release chemotactic chemicals esp. to signal fibroblasts)

Front 326

Steps in the proliferation phase, according to the chart on page 26:

Back 326

- epithelialization (uninjured epithelial cells from the margins reproduce and migrate over the surface of area)
- fibroplasia/collagen production (concurrent reduction of fibrin clot; initially immature, weak type III collagen; by day 12 replacement with stronger type I collagen starts; 6 weeks to 80% strength)
- wound contracture (pulls edges together; myofibroblasts = fibroblasts contractile like smooth muscle)
- neovascularization (by angiogenesis; new vascular network, anasomosis to preexisting vessels, or coupling; then retract to give mature scar more whitish appearance

Front 327

What is healing by delayed primary intention?

Back 327

first letting the wound heal by contraction, then approximating the wound's edges with sutures or skin grafts

Front 328

During proliferation phase, how does the scar appear, and why?

Back 328

red and swollen

from increase in vascularity and fluid, innervation of healing site, relative immaturity of the tissue that is weak and can bleed easily and is tender to tension or pressure)

Front 329

Steps in the maturation phase, according to the chart on page 26:

Back 329

- collagen synthesis/lysis balance (remodeling via collagen turnover; may last 12-24 months post injury)
- collagen fiber orientation (collagen in scar less organized than surrounding tissue; elastin not present)
- healed injury

Front 330

What is the longest phase in the healing process?

Back 330

maturation

Front 331

What is a contracture?

Back 331

uncontrolled wound contraction

highly resistive to passive stretch
may result from:
- fibrosis of tissues surrounding a joint
- adhesions
- muscle shortening
- tissue damage

Front 332

What is type I collagen?

Back 332

the primary collagen in bone, skin, and tendon; also the predominant collagen in mature scars

Front 333

What is type II collagen?

Back 333

the predominant collagen in cartilage

Front 334

What is type III collagen?

Back 334

collagen found in the gastrointestinal tract, uterus, and blood vessels

also the first type of collagen to be deposited during the healing process

Front 335

What are the four potential outcomes from an acute inflammatory process?

Back 335

- complete resolution and replacement of injured tissue with like tissue
- healing by scar formation
- formation of an abscess
- progression to chronic inflammation

Front 336

What is chronic inflammation?

Back 336

the simultaneous progression of active inflammation, tissue destruction, and healing

Front 337

How does chronic inflammation arise?

Back 337

one of two ways:

- after acute inflammation and can be result of persistence of injurious agent or another interference with healing process

- result of immune response to either an altered host tissue or a foreign material (such as an implant or suture) or the result of an autoimmune disease

Front 338

How long does acute inflammation last?

Back 338

no more than 2 weeks

Front 339

What is inflammation lasting more than 4 weeks called?

Back 339

subacute inflammation

Front 340

How long does chronic inflammation last?

Back 340

months or years

Front 341

What are the primary cells involved in chronic inflammation?

Back 341

mononuclear cells, including:
- lymphocytes,
- macrophages/monocytes
- eosinophils (occasionally)

Front 342

What are the primary determinants of the outcome of any injury?

Back 342

- type and extent of injury
- regenerative capacity of involved tissues
- vascular supply of injured site
- extent of damage to extracellular framework

Front 343

Why does cartilage have a limited ability to heal?

Back 343

it lacks lymphatics, blood vessels, and nerves

Front 344

Is it more helpful to the healing process to have a cartilage injury alone, or in conjunction with the subchondral bone?

Back 344

in conjunction with the bone

cartilage alone is avascular and has difficulty healing

if subchondral bone is involved, the cartilage can gain access to inflammatory cells and produce granulation tissue, although this cartilage will still be weaker and predisposed to degeneration and erosion

Front 345

How well do tendons heal?

Back 345

under the right circumstances, they can achieve a state of repair close to regeneration, especially if the synovial sheath is undamaged

Front 346

How well do ligaments repair?

Back 346

depends on type of ligament, size of defect, and amount of loading used

some are more avascular and don't heal as well

mature ligamentous repair tissue is still 30-50% weaker than uninjured ligament

Front 347

What is myositits ossificans?

Back 347

a calcified hematoma in muscle tissue after severe contusion

they are rare after surgery if hemostatis is controlled

Front 348

What are the stages of fracture healing?

Back 348

- impaction
- induction
- inflammation
- soft callus
- hard callus
- remodeling

Front 349

What are nociceptors?

Back 349

receptors of noxious (harmful) stimuli (e.g., pain)

Front 350

Pain comprises:

Back 350

- activation of nociceptors
- sensory experiences
- suffering
- alterations in behavior associated with such activation

Front 351

What are the goals of pain management?

Back 351

- resolving the underlying condition
- modifying the patient's perception of the discomfort
- maximizing function within the limitations

Front 352

What is acute pain?

Back 352

pain of less than 6 months duration for which an underlying pathology can be identified

Front 353

What is chronic pain?

Back 353

pain that persists beyond the normal time for tissue healing

usually the result of activation of dysfunctional neurological or psychological responses that cause the individual to continue to experience the sensation of pain even when no damaging or threatening stimulus is present

Front 354

What is referred pain?

Back 354

experience of pain in one area when the actual or potential tissue damage is in another area

Front 355

How can knowing if the patient's pain is acute, chronic, or referred help the therapist?

Back 355

it can help determine the mechanisms and processes that may be contributing to the sensation and facilitate selection of the most appropriate intervention to control or relieve this system

Front 356

How does acute pain serve a protective function after injury?

Back 356

by limiting activity to prevent further trauma and promote healing and recovery

Front 357

How is chronic pain classified?

Back 357

by pathophysiology:

- nociceptive pain
- neuropathic pain
- mixed pain syndrome
- psychological pain

Front 358

Chronic nociceptive pain causes and examples:

Back 358

caused by stimulation of pain receptors by noxious mechanical, chemical, or thermal stimuli and associate with ongoing tissue damage

e.g., arthritis, ischemia, cancer, chronic pancreatitis

Front 359

Chronic neuropathic pain causes and examples:

Back 359

result of peripheral or central nervous system dysfunction without ongoing tissue damage

e.g., diabetic neuropathy, postherpetic neuralgia, and phantom limb pain

Front 360

Chronic mixed pain syndrome causes and examples:

Back 360

those with multiple or uncertain pathophysiology

e.g., recurrent headache and some vasculitic syndromes

Front 361

Chronic psychological pain syndromes causes and examples:

Back 361

syndromes in which psychological processes play a large role

may be seen in somataform disorders and conversion reactions

Front 362

What are the three ways it is thought that pain is referred?

Back 362

- from a nerve to its area of innervation
- from one area to another derived from the same dermatome
- from one area to another derived from the same embryonic segment

Front 363

Describe the current thought on pain transmission:

Back 363

specific nerve endings (nociceptors) respond to all painful stimuli

specific nerve types (small, myelinated A-delta fibers and unmyelinated C fibers) transmit the sensation of pain from these nociceptors to the spinal cord

from the spinal cord, within specific tracts, to the brain

Front 364

Quality of pain depends upon:

Back 364

type of tissue from which the stimulus originates

which of the two nerve types transmits the pain (A-delta or C fibers)

Front 365

Intensity of the pain is related to:

Back 365

the firing rate of the nerves

Front 366

Pain from cutaneous noxious stimulation is usually perceived as:

Back 366

sharp, pricking, tingling

easy to localize

Front 367

Pain from musculoskeletal structures is usually:

Back 367

dull, heavy, or aching

harder to localize

Front 368

Pain from viscera:

Back 368

has an aching quality similar to musculoskeletal pain, but tends to refer superficially rather than deeply

Front 369

Pain transmitted by C fibers is usually:

Back 369

dull, long-lasting and aching

Front 370

Pain transmitted by A-delta fibers is generally:

Back 370

sharp

Front 371

Nociceptors can be activated by intense:

Back 371

thermal, mechanical or chemical stimuli from exogenous or endogenous sources

Front 372

Examples of:

exogenous chemical stimuli
endogenous chemical stimuli

Back 372

- acid or bleach

- bradykinin, histamine, arachidonic acid (these chemicals are part of the normal inflammatory response, but can also activate nociceptors; since they remain after the initial physical stimulus has passed, they can also prolong pain)

Front 373

Which fiber action is generally not blocked by opiates, A-delta or C?

Back 373

A-delta

Front 374

What is the ratio of A-delta to C fibers?

Back 374

20% are A-delta
80% are C fibers

Front 375

A-beta fibers, or wide dynamic-range neurons, have relatively large myelinated axons that conduct impulses ____ ____ than A-delta and C fibers.

Back 375

more quickly

Front 376

Where are the receptors for A-beta fibers located?

Back 376

- skin
- bones
- joints

Front 377

What types of sensations do A-beta fibers transmit?

Back 377

- vibration
- stretching of skin
- mechanoreception
- do not transmit pain

Front 378

While A-beta fibers don't normally transmit pain, what happens in cases of neuropathy and central sensitization?

Back 378

these A-beta neurons alter their transduction so that normal stimuli result in pain

this alteration in nerve function is key in prolonged pain

Front 379

How does pain gating work?

Back 379

nociceptors receive an excitatory pain signal and send it off via A-delta and/or C fibers, which relay the signal to the dorsal horn

transmission cells (interneurons in the dorsal horn) are either excited by the A-delta/C fibers or inhibited by nonnociceptive A-beta fibers (thus opening or closing the gate)

Front 380

Describe A-beta fibers:

Back 380

nonnociceptive
large-diameter
myelinated
release norepinephrine, serotonin, and enkephalins to modulate flow of afferent pain pathways

Front 381

Balance of the excitatory A-delta/C fiber impulses and the inhibitory A-beta fiber impulses determines:

Back 381

whether the individual feels pain

how severe the pain sensation is

Front 382

What is pain gating?

Back 382

inhibition of pain by inputs from nonnociceptor afferents

Front 383

How does the pain-spasm-pain cycle work?

Back 383

- nociceptor is activated
- impulse via A-delta/C fiber to dorsal horn
- transmission cell (T cell) activates and stimulates anterior horn cell to cause a muscle fiber to contract
- contraction results in fluid accumulation,increase in tissue irritants, and mechanical compression of nociceptor
- nociceptor activation increases (repeat!)

Front 384

Lateral spinothalmic tract projects:

Back 384

directly to the medial area of the thalamus

lateral spinothalamic tract - transmits sharp pain, localized (A-delta fiber)

Front 385

Anterospinothalamic tract separates:

Back 385

from the lateral spinothalamic tract in the brain stem to synapse with neurons in the reticular formation and the hypothalamic and limbic systems, to then project to lateral, ventral, and caudal areas of the thalamus

anterospinothalamic tract - transmission of more prolonged, aching pain, involve disturbing emotions (C fiber)

Front 386

Anterospinothalamic tract also relays information to

Back 386

the periaqueductal grey matter

Front 387

What is in the periaqueductal grey matter?

Back 387

thought to contain a large concentration of opiate receptors for pain modulation

Front 388

First-order neurons synapse in the dorsal horn with second-order neurons to project to:

Back 388

the thalamus
(via the lateral spinothalamic tract - sharp, or
via the anterospinothalamic tract - aching)

Front 389

Second-order neurons synapse in the thalamus with third-order neurons to project to the _____.
Why?

Back 389

cortex

so the sensation of pain can reach consciousness

Front 390

Examples of inhibition or modification of pain transmission or perception:

Back 390

- rubbing or shaking an injured area

- stress can cause pain not to be felt at time of injury

Front 391

What device was developed based on the gate control theory of pain modulation?

Back 391

the transcutaneous electrical nerve stimulation (TENS) unit

Front 392

Who first proposed the gate control theory of pain modulation, and when?

Back 392

Melzack and Wall
1965

Front 393

What types of treatments are thought to work based on activating nonnociceptive nerves (A-beta fibers) and causing gating of pain?

Back 393

- transcutaneous electrical nerve stimulation (TENS)
- electrical stimulation (ES)
- traction
- compression
- massage

Front 394

What are opiopeptins?

Back 394

(previously known as endorphins)

endogenous opiate-like peptides
control pain by binding to specific opiate receptors in the nervous system

Front 395

What endogenous peptides function similar to morphine?

Back 395

methionine-enkephalin (met-enkephalin)
leucine-enkephalin (leu-enkephalin)
beta-endorphin
dynorphin A and B

Front 396

How is pain suppression by stress suspected to work?

Back 396

it is most likely caused by increased opiopeptin (endorphin) levels at the spinal cord and higher CNS centers

Front 397

The endogenous opiate theory also explains:

Back 397

why there is a paradoxical pain-relieving effect of painful stimulation and acupuncture

Front 398

What things are important to consider when assessing a patient's pain?

Back 398

- source
- intensity
- duration
- how it affects function, activity, and participation

Front 399

What are the basic categories of pain management approaches?

Back 399

- controlling inflammation
- altering nociceptor sensitivity
- increasing binding to opiate receptors
- modifying nerve conduction
- modulating pain transmission at the spinal cord level
- altering higher-level aspects of pain perception

Front 400

What is the primary intervention used to alleviate pain?

Back 400

administration of pharmacological agents

Front 401

Why may physical agents be more appropriate than pharmacological agents for pain control?

Back 401

they may be able to effectively control pain with fewer adverse effects

Front 402

How do phamacological analgesic agents control pain?

Back 402

- by modifying inflammatory mediators at the periphery
- altering pain transmission from the periphery to the cortex
- altering the central perception of pain

Front 403

Upon what does selection of a particular pharmacological analgesic agent depend?

Back 403

- cause of pain
- length of time patient is expected to need the agent
- side effects of the agent

Front 404

What is the primary method of pain management?

Back 404

administration of a systemic analgesic

Front 405

Which requires higher doses of NSAIDs, reducing pain or reducing inflammation?

Back 405

reducing inflammation