Chronic Pain Presentation Ergonomics

1. Chronic Pain PresentationErgonomics Will Inkley, Corrin Porter, Ben MacPherson, Kevin McCrae, Chana Martins

2. What is Chronic Pain? • Chronic pain was previously defined as pain lasting longer than 6 months. • It is now defined as pain lasting longer than the normal course of time associated with a particular injury.

3. What is Chronic Pain? • Occasionally occurs in the absence of tissue injury • Chronic pain results from damage within the pain pathways in the peripheral nerves or the central nervous system

4. Causes of Chronic Pain • Pain can be cause by malignancy (cancer) • Non-malignant pain can have a variety of causes including: • Arthritis • neuropathy/neuralgia • back pain caused from spinal stenosis, degenerative disc disease, spinal disc herniation • migraines and other headaches, • bowel disorders.

5. Causes of Chronic Pain • Also including conditions such as: • Fibromyalgia • reflex sympathetic dystrophy • Lupus • multiple sclerosis • other neuromuscular conditions

6. Chronic Back Pain • Examples of back pain caused by chronic pain can be caused by any one of these factors: • Improper lifting and carrying of heavy objects • Being overweight, which put excess strain on the lower back • Traumatic injury • Wearing high heels • Sleeping on a poor mattress • Poor posture • Aging of the spine (degenerative changes) • Congenital condition such as curvature of the spine

7. What is neurology? Neurology is the scientific study of the nervous system, which includes the central nervous system and the peripheral nervous system. Understanding neurology and neural pathways in the human body is important for developing an understanding of chronic pain.

8. Types of Receptors in the Human Body • Photoreceptors: visible wavelengths of light • Mechanoreceptors: Examples are skeletal muscle receptors, baroreceptors sensitive to mechanical energy • Thermoreceptors: sensitive to heat and cold • Osmoreceptors: detect changes in the concentration of solutes in body fluids

9. Types of Receptors • Chemoreceptors: sensitive to specific chemicals • Nociceptors or pain receptors are specifically sensitive to tissue damage such as pinching or burning or distortion of tissue • However, intense stimulation of any receptor is also perceived as painful

10. Nociceptors • Mechanical nociceptors • Respond to mechanical damage such as cutting, crushing, or pinching • Thermal nociceptors • Respond to temperature extremes, especially heat • Polymodal nociceptors • Respond equally to all kinds of damaging stimuli, including irritating chemicals released from injured tissues

11. How is pain felt? • We feel pain via neural pathways throughout the body. • In chronic pain, a stimulus may not be present however the individual still experiences pain • This is caused by a “scrambled” message or a disrupted pathway

12. How is pain felt? • Under a normal pain stimulus, a person’s response would usually follow a specific pathway: • Nociceptor is stimulated, causing an action potential in afferent pain fiber • Signal is processed in the CNS and the brain decides how the body is to react • Signal leaves CNS via Ventral Root and is sent back along the efferent neuron to muscle fiber causing the reaction to the stimulus

13. Neurotransmitters • Two common pain NT are Substance P and Glutamate • Substance P – pain signals are transmitted to the higher brain for further processing • somatosensory cortex, the thalamus, and the reticular formation • Glutamate – an excitatory NT, binds to various receptors causing an influx of chemicals which leads to an increased number of action potentials

14. Body’s Natural Pain Suppressor • CNS has a natural pain suppressing system or analgesic system • Analgesic system depends on the presence of opiate receptors. • Endogenous Opiates: • Endorphins, Enkephalins, and Dynorphin

15. Body’s Natural Pain Suppressor • The brains response to pain is to release the chemicals into the body to reduce the severity of the painful sensation • With Chronic Pain, the individuals usually have lower levels of these pain suppressing chemicals

16. Neural Pathway in the Human Body

17. Chronic Pain Syndromes Some common syndromes are: • Most common type of pain is headache pain (99% of people experience a headache at some point in their lives) • Low Back Pain  • Arthritis Pain   • Cancer Pain

18. Assessment of Chronic Pain Five tests to be administered • Pain Drawings • The McGill Pain Questionnaire • The Visual Analog Scale • Numeric Pain Rating Scale • The Oswestry Low Back Disability Questionnaire

19. Treatment • Most treatments do not resolve all pain • Treatments should reduce pain and frequency of occurrence • Important for patient and doctor to collaborate and find best suited treatment

20. Treatment • Medicines • Pain relievers • Acetaminophen • NSAIDs • Narcotics • Long and short acting opioids • Antidepressants • beneficial effects of improved mood, decreased anxiety, and improved sleep cycle

21. Treatment • Therapy • Physical Therapy • Occupational Therapy • Behavioural Therapy • Acupuncture • Yoga

22. Treatment • Lifestyle Changes • Regular sleep • Stop smoking • Treat medical conditions and health concerns early • Exercise regularly • Schedule day so you are most active when you have more energy • Eat properly • Reduce stress

23. Ergonomic Applications The Goal of improving the workplace is too achieve greater performance and decrease the symptoms of chronic pain. Ergonomic adjustments are necessary for a healthy workplace and dealing with chronic pain. The following adjustments can be made:

24. Use task rotation. Chronic pain is associated with overuse injuries, therefore performing different tasks during the day to avoid undue stress and repetition. Use work enlargement. Combine jobs of different motion patterns. This process might require redesigning the workplace Adjustments to the Workplace • Adjust the work standard. • Chronic pain can hinder the amount of quality work that can be done continuously. • Changing the standard of performance will allow the worker to continue to work with out further injury • Use mechanical aids. • Changing the surrounding, by using ergonomic aids: • New Chair • Adjustment of height for work station • Improving grip of tools

25. Things to Avoid • Forceful actions • Have these tasks delegated or adjusted to reduce stress • Repetitive actions • Avoid rotating at the lower back, tilting neck to shoulder when on the phone • Tips to reducing stress in the workplace: • Select tools to reduce weight. • Pick up fewer objects at a time to reduce weight. • Push rather than pull. • Use a cart or trolley to transport materials. • Enlarge grip size. • Select gloves that improve your grip on an object.

26. Computer Applications VDTs Keyboards Mouse Vibration Dealing with work areas that involve levels of vibration Four areas of the Workplace • Standing Position • Improving posture to lower the incidence of pain • Seating Posture • Chair Height • Work station height • Armrests

27. Standing posture • In a standing position there is more dynamic stress placed on the body then when in a seated position. The low back is a very sensitive area when working from a standing position. • Workstation heights and angles must be custom adjusted to the worker in way that the body can maintain an unstrained, comfortable position with your arms, forearms, and shoulders relaxed. • Example a Drafting Table

28. Vibration Vibration can be very detrimental to chronic pain suffers and can increase there level of pain. • Manual labour jobs that include vibration can include construction worker using • Hammers • Power Tools (Drills, Jackhammers, Impact Wrench ect)\ • Workers dependant on working with such tools can use vibration damping devices like gloves or improved grips • Some workers may need to minimize exposure to vibration which could lead to time lost at work

29. Seating Posture • Begins with what you are sitting in • The style and design of the chair must fit the height and weight of the worker. • Adjustable lumbar support, arm rests and seat height are a must for any worker who primarily works at a desk • Tips to reducing stress from sitting a chair all day • Try to relax. Many injuries and painful episodes arise from continuously tensing your neck and shoulder muscles while working • Change your body position periodically throughout the day. • Durable comfortable slip-resistant fabric

30. Computer Applications VDT (Video Display Terminals) • VDT’s are work stations that include monitors, keyboards, mouse, and the CPU • Appropriate monitor angle is needed for reduced strain on the neck muscles • Work with proper lighting • Arrange a desk lamp to effectively light your keyboard and source material  • When using source documents arrange them to be inline with the monitor. This reduces eye fatigue when moving from one source to the next. • Use appropriate keyboards and mouse with corresponding arm and hand rests.