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24 Cards in this Set
- Front
- Back
Pain pathways/Neurophysiology
Fast Pain |
-Transmitted over A delta fibers. -crosses to excite lateral (neo) spinothalamic tract -Function: localization, discrimination of pain |
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Pain pathways/Neurophysiology
Slow Pain |
-Transmitted over C fibers - Cross to excite anterior spinothalamic track -Functions: for diffuse arousal (protective/aversive reactions), affective and motivational aspect of pain |
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Pain pathways/Neurophysiology
Intrinsic Inhibitory Mechanisms |
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
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Pain pathways/Neurophysiology
Intrinsic Inhibitory Mechanisms continued... |
Descending analgesic systems: endogenous opiates produced throughout CNS can depress pain transmission at various sites through mechanisms of presynaptic inhibition |
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Acute pain |
-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 |
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Chronic Pain |
-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 |
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Pain Syndromes: Neuropathic pain |
-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 |
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Thalamic Pain |
continuous, intense pain occurring on the contralateral hemiplegic side; result of a stroke on ventral posterolateral thalamus
-poor rehab potential |
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Complex Regional Pain Syndrome Type I |
-Pain maintained by efferent activity of sympathetic nervous system
-Associated w/ traumatic injury
- Abnormal burning pain, hypersensitivity to light touch and sympathetic hyperfunction |
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Disorders of peripheral roots & nerves |
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 |
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Herpes Zoster (Shingles) |
-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; |
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Phantom limb pain |
-Pain in a limb following amputation of that limb
-Not phantom limb sensation |
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Psychosomatic pain |
Origin of pain experience due to mental or emotional disorder
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Headache & craniofacial pain |
E.g. temporomandibular joint syndrome (TMJ) |
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Referred pain |
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 |
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Assessment of Chronic Pain |
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 |
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Assessment of Chronic Pain continued... |
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 |
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Pain rating scales |
-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 |
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Physical examination |
-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 |
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Postural stress syndrome |
chronic muscle lengthening and/or shortening that causes postural mal-alignment and stress to soft tissue |
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Movement adaptation syndrome |
Habituated movement dysfunction |
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OT Intervention for Pain |
-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 |
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OT intervention for Pain continued... |
Assist: developing strategies / using techniques to manage pain -provide relaxation training: progressive relaxation techniques, guided imagery, biofeedback Refer to other professions for direct pain intervention |
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OT Intervention for Pain continued... |
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 |