Therapy Ed Chapter 7 Pain

Front 1

Pain pathways/Neurophysiology

Fast Pain

Back 1

-Transmitted over A delta fibers.

-crosses to excite lateral (neo) spinothalamic tract

-Function: localization, discrimination of pain

Front 2

Pain pathways/Neurophysiology

Slow Pain

Back 2

-Transmitted over C fibers

- Cross to excite anterior spinothalamic track

-Functions: for diffuse arousal (protective/aversive reactions), affective and motivational aspect of pain

Front 3

Pain pathways/Neurophysiology

Intrinsic Inhibitory Mechanisms

Back 3

Gate control theory: transmission of sensation at spinal cord level is controlled by balance bwtn large fibers and small fibers.

Activity of large fibers @ level of 1st synapse can block activity of small fibers and pain transmission

Front 4

Pain pathways/Neurophysiology

Intrinsic Inhibitory Mechanisms continued...

Back 4

Descending analgesic systems: endogenous opiates produced throughout CNS can depress pain transmission at various sites through mechanisms of presynaptic inhibition

Front 5

Acute pain

Back 5

-Pain provoked by noxious stimulation

-Associated w/ underlying pathology (injury, acute inflammation/disease)

-Signs include: sharp pain and sympathetic changes (increased HR/blood pressure, pupillary dilation, sweating, anxiety

Front 6

Chronic Pain

Back 6

-Pain that persists beyond the usual course of healing

-Symptoms persist longer than 6 months; no underlying pathology can be ID'd or may never have been present

Front 7

Pain Syndromes: Neuropathic pain

Back 7

-Pain as a result of lesions in some part of the nervous system; usually accompanied by some degree of sensory deficit

Types: Thalamic

Complex Regional Pain Syndrome Type I

DIsorders of peripheral roots and nerves

Herpes Zoster (shingles)

Phantom limb

Musculoskeletal pain

Psychosomatic pain

Front 8

Thalamic Pain

Back 8

continuous, intense pain occurring on the contralateral hemiplegic side; result of a stroke on ventral posterolateral thalamus

-poor rehab potential

Front 9

Complex Regional Pain Syndrome Type I

Back 9

-Pain maintained by efferent activity of sympathetic nervous system

-Associated w/ traumatic injury

- Abnormal burning pain, hypersensitivity to light touch and sympathetic hyperfunction

Front 10

Disorders of peripheral roots & nerves

Back 10

Complex Regional Pain Syndrome Type II: pain occurring along the branches of a nerve

Radiculalgia: neuralgia of nerve root

Paresthesias, allodynia: w/ nerve injury or transection

Front 11

Herpes Zoster (Shingles)

Back 11

-Acute, painful mononeuropathy caused by varicella-zoster virus

-Vesicular eruption & marked inflammation of posterior root ganglion of the afferent spinal nerve

-Infections can last from 10 days to 5 weeks; Pain may persist for months;

Front 12

Phantom limb pain

Back 12

-Pain in a limb following amputation of that limb

-Not phantom limb sensation

Front 13

Psychosomatic pain

Back 13

Origin of pain experience due to mental or emotional disorder

Front 14

Headache & craniofacial pain

Back 14

E.g. temporomandibular joint syndrome (TMJ)

Front 15

Referred pain

Back 15

pain arising from deep visceral tissues; felt in body region remote from site of pathology; results in tenderness and cutaneous hperalgesia

E.g. medial left arm pain w/ heart attack

Front 16

Assessment of Chronic Pain

Back 16

1. History: chief complaint, description, location

2. Determine Localization: chronic pain poorly localized

3. ID nature of pain: constant, intermittent

4. Determine irritating stimuli/activities

5. Determine subjective ax's using pain intensity rating scales

6. Physical examination

Front 17

Assessment of Chronic Pain continued...

Back 17

7. Assess degree of suffering:

8. Assess for functional change

9. Assess for consequences of pain, impact

10. Assess depression/anxiety

11. access for prescription drug misuse

12. Assess for dependence on health care system; shopping around behavior

13. Determine responsiveness of pain to physiological interventions/treatments

14. Determine: motivational/affective components

Front 18

Pain rating scales

Back 18

-Simple descriptive scale : verbal report

-Semantic differentiation scales (e.g. McGill Pain)

-Visual analog scale

-Spatial distribution of pain: using drawings to plot location, type of pain

Front 19

Physical examination

Back 19

-ID of underlying pathology (cause of pain); objective physical findings usually not easily ID'd

- Assess all systems

-Check for postural stress syndrome

-Check for movement adaptation syndrome

-Check for autonomic changes

-assess for abnormal movements

Front 20

Postural stress syndrome

Back 20

chronic muscle lengthening and/or shortening that causes postural mal-alignment and stress to soft tissue

Front 21

Movement adaptation syndrome

Back 21

Habituated movement dysfunction

Front 22

OT Intervention for Pain

Back 22

-Education about contributing factors

-Help ID and respond adaptively to pain behaviors

-remove behavioral reinforcers

-establish behavior contact

-provide positive reinforcers/education support

-Demonstrate change, allow person to exp. success

Front 23

OT intervention for Pain continued...

Back 23

Assist: developing strategies / using techniques to manage pain
- teach coping skills/stress management

-provide relaxation training: progressive relaxation techniques, guided imagery, biofeedback

Refer to other professions for direct pain intervention

Front 24

OT Intervention for Pain continued...

Back 24

Establish a realistic daily activity program

- improve overall level of conditioning

- improve overall functional capacity (i.e. mobility, ADL, meaning occupations)

-prescribe assistive tech as appropriate

- teach energy conservation techniques

Provide meaningful diversional activities