Podcast
Questions and Answers
What is an objective method used to assess pain hypersensitivity?
What is an objective method used to assess pain hypersensitivity?
- Quantitative Sensory Testing (QST) (correct)
- Pain Catastrophizing Scale
- Clinical examination
- Fear and Avoidance Questionnaire
Which tool is NOT commonly used in sensory testing for neuropathic pain?
Which tool is NOT commonly used in sensory testing for neuropathic pain?
- Tuning fork for vibration
- Cold/warm objects for temperature
- Soft brush for touch
- Thermometer for temperature (correct)
How does central sensitization pain typically present in the body?
How does central sensitization pain typically present in the body?
- Only in dermatomal patterns
- Localized to the site of injury
- Limited to acute phases of injury
- Increased sensitivity at unrelated segments (correct)
Which of the following questionnaires is used to assess behaviors associated with central sensitization?
Which of the following questionnaires is used to assess behaviors associated with central sensitization?
What is a key aspect of understanding pain in physical therapy?
What is a key aspect of understanding pain in physical therapy?
What role do physical therapists play in pain management according to contemporary practices?
What role do physical therapists play in pain management according to contemporary practices?
How is chronic pain defined by the International Association for the Study of Pain (IASP)?
How is chronic pain defined by the International Association for the Study of Pain (IASP)?
What is a key characteristic of nociplastic pain?
What is a key characteristic of nociplastic pain?
Which statement best describes the shift in concepts in chronic pain management?
Which statement best describes the shift in concepts in chronic pain management?
Which time frame is typically used to define chronic pain?
Which time frame is typically used to define chronic pain?
What is the primary distinction between nociceptive pain and neuropathic pain?
What is the primary distinction between nociceptive pain and neuropathic pain?
Which of the following best describes peripheral sensitization?
Which of the following best describes peripheral sensitization?
What role does Substance P play in nociceptive pain?
What role does Substance P play in nociceptive pain?
According to the biopsychosocial model of pain management, which factor is NOT considered?
According to the biopsychosocial model of pain management, which factor is NOT considered?
What is the significance of differentiating between acute pain and chronic pain?
What is the significance of differentiating between acute pain and chronic pain?
What is a characteristic feature of nociplastic pain?
What is a characteristic feature of nociplastic pain?
Which condition is NOT classified as a nociplastic diagnosis?
Which condition is NOT classified as a nociplastic diagnosis?
What symptom is specifically associated with allodynia in nociplastic pain?
What symptom is specifically associated with allodynia in nociplastic pain?
Which mechanism is involved in nociplastic pain?
Which mechanism is involved in nociplastic pain?
What is the required duration for pain to be classified as chronic in nociplastic terms?
What is the required duration for pain to be classified as chronic in nociplastic terms?
What is one potential feature associated with nociplastic pain aside from pain sensation?
What is one potential feature associated with nociplastic pain aside from pain sensation?
What is hyperalgesia in the context of nociplastic pain?
What is hyperalgesia in the context of nociplastic pain?
What is characterized by increased sensitivity and reduced threshold of nociceptive neurons in the periphery?
What is characterized by increased sensitivity and reduced threshold of nociceptive neurons in the periphery?
Which statement about nociplastic pain is correct?
Which statement about nociplastic pain is correct?
Which phenomenon is NOT associated with evoked pain hypersensitivity?
Which phenomenon is NOT associated with evoked pain hypersensitivity?
Which of the following is a possible symptom of nociplastic pain?
Which of the following is a possible symptom of nociplastic pain?
Which condition indicates probable nociplastic pain?
Which condition indicates probable nociplastic pain?
What primarily comprises the 'inflammatory chemical soup' in the context of nociplastic pain?
What primarily comprises the 'inflammatory chemical soup' in the context of nociplastic pain?
How does central sensitization affect nociceptive neurons?
How does central sensitization affect nociceptive neurons?
Which of the following is NOT an indication of comorbidities in nociplastic pain?
Which of the following is NOT an indication of comorbidities in nociplastic pain?
What characterizes primary hyperalgesia?
What characterizes primary hyperalgesia?
What happens to C fibers when they become sensitized during inflammation?
What happens to C fibers when they become sensitized during inflammation?
Which of the following describes Central Sensitization?
Which of the following describes Central Sensitization?
What is a characteristic symptom of Central Sensitization?
What is a characteristic symptom of Central Sensitization?
Which statement about the dorsal horn in Central Sensitization is accurate?
Which statement about the dorsal horn in Central Sensitization is accurate?
Which area of the brain is involved in the processing of pain and stress as part of Central Sensitization?
Which area of the brain is involved in the processing of pain and stress as part of Central Sensitization?
What is primary hyperalgesia?
What is primary hyperalgesia?
Centralized sensitization can occur under which of the following conditions?
Centralized sensitization can occur under which of the following conditions?
Which of the following describes 'allodynia' as it relates to Central Sensitization?
Which of the following describes 'allodynia' as it relates to Central Sensitization?
Flashcards
Nociceptive Pain
Nociceptive Pain
A type of pain that occurs when tissues are damaged or injured. It is usually sharp, localized, and short-lived.
Neuropathic Pain
Neuropathic Pain
A type of pain that results from damage to nerves or the nervous system. It can be burning, tingling, or shooting in nature.
Nociplastic Pain
Nociplastic Pain
A type of pain that is caused by changes in the way the brain processes pain signals. It is often described as chronic, widespread, and unresponsive to traditional pain treatments.
How does Substance P contribute to pain?
How does Substance P contribute to pain?
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How does IASP categorize pain?
How does IASP categorize pain?
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Chronic pain: IASP definition
Chronic pain: IASP definition
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Chronic pain: ACR definition
Chronic pain: ACR definition
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Paradigm Shift in Pain Management
Paradigm Shift in Pain Management
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Calcitonin gene-related peptide (CGRP)
Calcitonin gene-related peptide (CGRP)
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Allodynia
Allodynia
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Hyperalgesia
Hyperalgesia
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Central Sensitization
Central Sensitization
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Peripheral Sensitization
Peripheral Sensitization
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Inflammatory Chemical Soup
Inflammatory Chemical Soup
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Normal Hypersensitivity after injury
Normal Hypersensitivity after injury
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Prolonged Hypersensitivity
Prolonged Hypersensitivity
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Primary Hyperalgesia
Primary Hyperalgesia
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What is Nociplastic Pain?
What is Nociplastic Pain?
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What is Allodynia?
What is Allodynia?
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What is Hyperalgesia?
What is Hyperalgesia?
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What is Touch Hypersensitivity?
What is Touch Hypersensitivity?
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How does Nociplastic Pain Develop?
How does Nociplastic Pain Develop?
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What are some conditions related to Nociplastic Pain?
What are some conditions related to Nociplastic Pain?
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What are the key clinical features of Nociplastic pain?
What are the key clinical features of Nociplastic pain?
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What is the core concept of Nociplastic pain?
What is the core concept of Nociplastic pain?
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Dorsal Horn Dysfunction
Dorsal Horn Dysfunction
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Secondary Hyperalgesia
Secondary Hyperalgesia
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Periaqueductal Gray (PAG)
Periaqueductal Gray (PAG)
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Central Sensitization in the Brain
Central Sensitization in the Brain
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What is neuropathic pain?
What is neuropathic pain?
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What is Quantitative Sensory Testing (QST)?
What is Quantitative Sensory Testing (QST)?
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What is central sensitization?
What is central sensitization?
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Study Notes
Chronic Pain Differential Diagnosing
- Chronic pain is a multifaceted issue, encompassing human behavior and physiology.
- The field of physical therapy recognizes pain as a complex phenomenon, requiring a more comprehensive understanding.
- Physical therapists need to identify pain processes as part of the evaluation process.
- The International Association for the Study of Pain (IASP) defines chronic pain as pain lasting longer than 3 months, without apparent biological purpose.
- The American College of Rheumatology (ACR) defines chronic pain as regional or widespread pain lasting for three months or more.
Types of Pain
- Nociceptive (acute): resulting from activation of nociceptors due to tissue injury or inflammation
- Mediated by Substance P and calcitonin gene-related peptide (CGRP).
- Neuropathic: due to damage or dysfunction of the nervous system
- Examples include diabetic neuropathy or carpal tunnel syndrome.
- Nociplastic: altered nociception despite no clear evidence of tissue damage
- A combination of peripheral and central sensitization.
- Associated with fatigue, sleep disturbances, cognitive difficulties, and hypersensitivity.
- Examples include fibromyalgia, complex regional pain syndrome, and irritable bowel syndrome.
- Caveats: nociplastic pain can occur with neuropathic pain mechanisms. Neuropathic pain may be a risk factor for nociplastic pain.
Pain Mechanisms: Peripheral and Central Sensitization
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Peripheral Sensitization: a prolonged hyper-responsiveness at the site of injury
- Chemical soup of inflammation
- Mediated by inflammatory chemicals, including NGF, bradykinin, prostaglandins, and substance P.
- Localized to the area of injury, resulting in primary hyperalgesia (increased pain sensitivity to a painful stimulus - e.g., heat or mechanical).
-
Central Sensitization: Increased responsiveness of nociceptive neurons in the CNS to normal or subthreshold input
- This may occur even without an initial injury or trigger event.
- The brain areas involved include the dorsal horn, periaqueductal gray (PAG), and the thalamus.
- Central sensitization can lead to persistent pain and hypersensitivity to various stimuli, including allodynia (pain from a non-painful stimulus), and widespread non-anatomically logical pain distribution.
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Dorsal Horn: plays a crucial role in central sensitization
- Increased input by C and Aδ fibers, combined with increased excitability.
- Modulation of the dorsal horn is transformed by pain, resulting in increased dominance of C fibers.
Testing and Evaluation
- Quantitative Sensory Testing (QST): objective method for assessing pain hypersensitivity.
- Apply various stimuli from vibration to touch.
- Central Sensitization Testing: assessment of different sensory functions and related symptoms
- Includes tests like tuning forks, for vibration; tactile stimuli with a brush for touch, warm and cold objects for temperature. This assesses the relationship between the stimulus and the perceived sensation.
- Questionnaires:
- Central Sensitization Inventory (CSI)
- Pain Catastrophizing Scale
- Brief Illness Perceptions Questionnaire
- Fear and Avoidance Questionnaire
Pain Management Considerations
- Current pain management approaches should consider the biopsychosocial model, emphasizing contemporary education and patient engagement in active, evidence-based strategies, rather than solely focusing on passive interventions.
- Pain is a multifactorial process, encompassing human behavior, pain physiology, and psychological factors.
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