Pain Management and Sensory Assessment

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Questions and Answers

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?

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?

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?

Central Sensitization Inventory (CIS) Signup and view all the answers

What is a key aspect of understanding pain in physical therapy?

Considering human behavior in the pain experience Signup and view all the answers

What role do physical therapists play in pain management according to contemporary practices?

Encouraging patients to engage actively in pain-management strategies Signup and view all the answers

How is chronic pain defined by the International Association for the Study of Pain (IASP)?

Pain persisting beyond normal tissue healing time Signup and view all the answers

What is a key characteristic of nociplastic pain?

It can occur alongside both neuropathic and nociceptive pain mechanisms. Signup and view all the answers

Which statement best describes the shift in concepts in chronic pain management?

Patient engagement in their management is essential. Signup and view all the answers

Which time frame is typically used to define chronic pain?

At least three months Signup and view all the answers

What is the primary distinction between nociceptive pain and neuropathic pain?

Nociceptive pain is due to tissue damage, while neuropathic pain is related to nerve damage. Signup and view all the answers

Which of the following best describes peripheral sensitization?

Alteration in pain perception primarily through biochemical changes at peripheral nerve endings. Signup and view all the answers

What role does Substance P play in nociceptive pain?

It acts as a key mediator in inflammatory processes associated with pain. Signup and view all the answers

According to the biopsychosocial model of pain management, which factor is NOT considered?

The influence of demographic variables like age and gender. Signup and view all the answers

What is the significance of differentiating between acute pain and chronic pain?

Understanding the type of pain helps guide targeted treatment approaches. Signup and view all the answers

What is a characteristic feature of nociplastic pain?

Involves hyper-responsiveness to nonpainful stimuli Signup and view all the answers

Which condition is NOT classified as a nociplastic diagnosis?

Osteoarthritis Signup and view all the answers

What symptom is specifically associated with allodynia in nociplastic pain?

Pain from a normally non-painful stimulus Signup and view all the answers

Which mechanism is involved in nociplastic pain?

Both peripheral and central mechanisms Signup and view all the answers

What is the required duration for pain to be classified as chronic in nociplastic terms?

More than 3 months Signup and view all the answers

What is one potential feature associated with nociplastic pain aside from pain sensation?

Cognitive disturbances Signup and view all the answers

What is hyperalgesia in the context of nociplastic pain?

Increased pain from an already painful stimulus Signup and view all the answers

What is characterized by increased sensitivity and reduced threshold of nociceptive neurons in the periphery?

Peripheral sensitization Signup and view all the answers

Which statement about nociplastic pain is correct?

It can coexist with nociceptive pain Signup and view all the answers

Which phenomenon is NOT associated with evoked pain hypersensitivity?

Increased sensitivity to movement Signup and view all the answers

Which of the following is a possible symptom of nociplastic pain?

Static mechanical allodynia Signup and view all the answers

Which condition indicates probable nociplastic pain?

The presence of all symptoms listed Signup and view all the answers

What primarily comprises the 'inflammatory chemical soup' in the context of nociplastic pain?

Chemical mediators and neuropeptides at the site of injury Signup and view all the answers

How does central sensitization affect nociceptive neurons?

It leads to increased responsiveness to normal stimuli. Signup and view all the answers

Which of the following is NOT an indication of comorbidities in nociplastic pain?

Localized inflammation only at the injury site Signup and view all the answers

What characterizes primary hyperalgesia?

Increased sensitivity to painful stimuli Signup and view all the answers

What happens to C fibers when they become sensitized during inflammation?

They increase their spontaneous response to diverse sensory information. Signup and view all the answers

Which of the following describes Central Sensitization?

Amplification of neural signals that leads to pain hypersensitivity. Signup and view all the answers

What is a characteristic symptom of Central Sensitization?

Unpredictable pain patterns. Signup and view all the answers

Which statement about the dorsal horn in Central Sensitization is accurate?

It loses its gatekeeping function and its excitability is increased. Signup and view all the answers

Which area of the brain is involved in the processing of pain and stress as part of Central Sensitization?

Periaqueductal gray (PAG). Signup and view all the answers

What is primary hyperalgesia?

Increased responsiveness to noxious stimuli at the injury site. Signup and view all the answers

Centralized sensitization can occur under which of the following conditions?

Without any recognizable trigger event. Signup and view all the answers

Which of the following describes 'allodynia' as it relates to Central Sensitization?

Pain sensation triggered by previously non-painful stimuli. Signup and view all the answers

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

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.
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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Description

This quiz focuses on key concepts in pain management, particularly relating to hypersensitivity and different pain types. It covers objective assessment methods, central sensitization, and the role of physical therapists in managing chronic pain. Test your knowledge on current practices and theories in understanding pain.