PHTY209 Lecture Notes - Lecture 17: Phantom Limb, Sympathetic Nervous System, Knee Replacement
Pain - the biopsychosocial model
• Define and explain pain to others (patients, people, community, colleagues) as a complex,
multidimensional experience
o An unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in the terms of such damage
o Modern pain research – Physiotherapy embracing wider-reaching and more dynamic
models of pain
o Crucial role in prevention strategies for chronic pain and for the restoration of
function in chronic pain disability
o Physiotherapists:
• Taught to be good listeners
• Time to understand our clients
• Explain things in detail and progressively over sessions
o Can positively empower pain suffers to adapt, take control of, reconstruct and
return their lives to more manageable states
o For the client in pain: complex interaction between physical (bio), psychological and
social factors, especially chronic pain
o Pain assessment and treatment of the client in pain must be considered from a BPS
perspective and approached within a multidisciplinary framework.
o The 3 dimensions of pain
• Sensory-discriminative: Sensation of pain – location, quality (burning, dull,
sharp), intensity and duration.
• Motivational-affective: The unpleasantness of pain or how much the pain
bothers the person. (Also need to look at emotions, moods, distress).
• Cognitive-evaluative: Puts pain in terms of past experiences and probability of
outcomes.
• Identify and analyse the differences between acute, acute-on-chronic, recurrent, and
chronic pain and the implications of these for pain assessment
o Define acute and chronic pain and explain the continuum that exists for the
transition from acute to chronic pain
• Acute pain:
▪ Direct result of tissue damage or potential tissue damage and is a
symptom
▪ Well defined time of onset with clear pathology
▪ Acute pain serves to protect from tissue damage and allow for healing
to occur
▪ Pain lasting less than 3 months
• Chronic pain:
find more resources at oneclass.com
find more resources at oneclass.com
▪ Pain can be considered chronic if:
Outlasts normal tissue healing time
The impairment is greater than would be expected from the
physical findings or injury; And/or
Occurs in the absence of identifiable tissue damage
▪ May be elicited initially by an injury/disease but perpetuated by factors
that are pathologically and physically remote from the original cause
▪ Pain lasting more than 3 months
• Acute -> chronic pain
▪ Represents a continuum
▪ Need to prevent progression from acute to chronic pain
▪ Also need to understand the different mechanisms and pain processes
at play in acute vs. chronic pain
o Indicate the contributing factors identified in the progression from acute to chronic
pain, both pathophysiological and psychosocial.
• Mechanisms for the progression
▪ Behavioural:
• Maladaptive adaptations keep the peripheral nociceptive barrage
going (e.g. changed postures, adapted avoided movements,
deconditioned tissues etc.)
▪ Pathophysiological processes:
• Sustained inflammation (neurogenic inflammation, NP)
• Changes in somatosensory system and pain processing -
peripheral nerves, spinal cord, higher central pain pathways and
the sympathetic nervous system (i.e. Central sensitisation
maintained beyond tissue healing timeframe – upregulation of
system and disinhibition)
• Reorganisation or remapping of the somatosensory cortex and
other cortical structures may contribute to development of
phantom limb pain, CLBP
• Descending pathways of pain control (facilitation rather than
inhibition/disinhibition)
▪ Psycho-social factors:
• The contribution of psychosocial factors to the pain experience is
important in acute and chronic pain as well as in the transition
from acute to chronic pain
• (Linton 2000; Ariens et al. 2001; Pincus et al. 2002) Clearly
identified in:
• LBP/Whiplash: talk about our yellow flags (tutorial activity)
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
The impairment is greater than would be expected from the physical findings or injury; and/or. Lbp/whiplash: talk about our yellow flags (tutorial activity: e. g. Pre-op anxiety: associated with higher pain intensities in the first hour after variety of operations and for one year after total knee replacement. Surgery pre-op studies we have such a vital role as physiotherapists in our pre-op assessment and treatment to change this continuum from acute to chronic pain. Links in with our biopsychosocial model (bps: pain neuromatrix. Fundamental principle of this approach is that pain is produced by the brain when it perceives that danger to body tissue exists and that action is required: pain is an output of the brain. Fear of pain pain anxiety symptoms scale (pass) Fear of work related activities fear avoidance belief. Yes: history of trauma to back, neurological signs- cauda equina including saddle anaesthesia.
