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Chapter 10 Pain

Chapter 10 Pain. Pain. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. International Association for the Study of Pain. Acute Pain

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Chapter 10 Pain

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  1. Chapter 10Pain

  2. Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. International Association for the Study of Pain

  3. Acute Pain Usually short lived and is associated with muscle strains, tendinitis, contusions, surgery or ligament injuries Chronic Pain Pain that persists after noxious stimulus has been removed. Types of Pain Referred Pain Pain that is felt at a site distant from the location of injury or disease.

  4. Microtrauma A long-standing or recurrent musculoskeletal problem that was not initiated by an acute injury. Macrotrauma An immediately noticeable injury involving a sudden, direct, or indirect trauma. Physiology of Pain – Source of Pain Activity exceeds the tissue's ability to remodel and repair

  5. Damage to central nociceptive system triggers non-nociceptive activity may elicit pain – non-nociceptive pain (NNP) Non-nociceptive Pain

  6. Pain Pathway Lowered firing threshold Receptive threshold expansion Spontaneous discharge Aberrant muscle activity CNS Articular dysfunction Ascending afferents Disordered proprioception Non-nociceptive input Spinothalamic tract Nociception Spinal cord A&C fibers

  7. Pain Theory – Gate Control

  8. Examination and Evaluation Use of Questionnaires • Assess affective qualities of pain • Assess pain intensity • Assess psychological aspects of pain

  9. Pain Scales • Visual analogue scale (VAS) – Pain intensity • McGill Pain Questionnaire (MPQ) – More sensitive, but longer than VAS; three categories (sensory, affective, evaluative)

  10. Disability and Health-Related Quality of Life Scales • Quality of Well-Being Scale (QWB) • Sickness Impact Profile (SIP) • Duke Health Profile (DHP) • Short Form-36 (SF-36) • The Oswestry Low Back Disability Questionnaire • Waddell Disability Index • Disability Questionnaire • Arthritis Impact Measurement Scales Often used with disease- specific tools:

  11. Therapeutic Exercise Intervention for Pain Acute • Combination of medication, gentle exercise, ice (within first 24 hours). • Exercise directed at restoring motion, strength, and function.

  12. Exercise Intervention for Chronic Pain • Often requires a team approach. • Realistic goals and patient education are crucial. • Goals may extend beyond treatment of impairments. • Exercise is used to inhibit pain, facilitate non-nociceptive input, while addressing impairments and functional limitations.

  13. Activity and Mode • Depends on source of pain and results of evaluation. • Should focus on awareness and use of proper posture. • Incorporation of movement therapies (e.g., Feldenkrais) is helpful in restoring movement patterns. • Aerobic exercise (low impact) is helpful for chronic pain.

  14. Dosage • Dosage should not increase pain. • Sessions may be brief initially to assess response. • Frequency is determined by activity type, purpose, and quantity prior to experience of pain = “pain-free dosage.” • Functional progression to previous activity levels.

  15. Medications Massage therapy Relaxation techniques Biofeedback Psychological care Acupuncture Heat Cold Transcutaneous electrical stimulation (TENS) Adjunctive Agents

  16. Summary • Pain impairment occurs with most musculoskeletal conditions and must be treated as a primary impairment along with any secondary limitations that may result. • Nociceptors transmit pain via A&C fibers. • Information is processed w/in SC and then ascends via contralateral spinothalamic tract to thalamus. • Gate theory – Incoming information from non-pain receptors can close the gate to pain information.

  17. Summary – (cont.) • Chronic pain may result from increased sensitization of nociceptors and spinal level changes that perpetuate + feedback loops in the pain-spasm pain cycle. • Descending impulses can influence pain perceptions through several mechanisms, including endogenous opiates. • Pain can be assessed through direct measurement tools (questionnaires).

  18. Summary – (cont.) • Therapeutic exercise is a cornerstone of treatment for chronic pain. • TENS, heat, cold, and medications are components of a comprehensive treatment program.

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