Pain Upper pt1

• Nociplastic pain:

  • pain that doesnt arise from nerve injury/disease or tissue injury/disease, but due to abnormal processing of nociception somewhere in the system
  • "pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain"
• • What do all these have in common:
  • chronic whiplash associated disorder
  • phantom limb pain
  • chronic low back pain
  • fibromyalgia
  • complex regional pain syndrome type 1
  • all of the above:
  • pain that persists beyond natural healing time
  • weak or no association between severity and prognosis and measures of tissue injury
  • associated with signs of sensitisation of normal sensory processing
  • influenced by interplay of psychological factors
• Mature Organism Model:

  • the brain samples itself from:
  • past experiences
  • knowledges
  • beliefs
  • culture
  • past successful behaviours
  • past successful behaviours observed in others
  • past unsuccessful behaviours
  • all of this is used to created an output, which might be pain, but the experience of pain will be the results of the scrutinising process and so will our behavioural changes and so will our physiological and stress responses
• • where theres been a disease or amputation, the area for that body part is removed in the somatosensory cortex and the areas around that take over e.g. upper limbs amputation will lead to neuroplastic reorganisation where the legs and face area will take over that region on the somatosensory cortex
• • people with chronic lower back pain have more areas of the brain light up due to the nociceptive information compared to healthy people
• This makes my brain hurt - what does it mean?

  • this might mean that the CNS might sometimes drive the generation of pain that is disproportionate to, or in the absence of, tissue damage
  • it means that if a patients pain doesnt fit neatly into an obvious pattern it doesn't mean its real
  • this phenomena might underpin or contribute to nociplastic pain
• • in relation to tissue injury, changes in the tissue, in the sensitisation of afferents, we can see changes in the sensitivity and reactivity of the dorsal horn and changes in all other levels of the CNS
  • we can see possible changes in actual brain structure and function and we see changes in the normal stress and hormonal response to nociceptive stimuli
• Psychological factors:

  • chronic pain pts have been shown to demonstrate:
  • anxiety/distress/depression
  • catastrophising
  • external locus of control
  • may be predictive of prognosis (more than measures of tissue damage or pathology)
• The fear avoidance model:

  • consists of 2 paths after an injury
  • one path consists of experiencing pain, but no low mood, not in distress and not worries about what it means, they confront the pain and end up with a good recovery
  • the other path is that after experiencing pain, they make it seem worse than it is, catastrophising it, being fearful of movements and normal behaviours, becoming avoidant, leading to disuse, depression and disability, becoming a cycle

  
• Someones idea of their pain consists of:

  • the actual pain
  • attitudes and beliefs
  • psychological distress
  • illness behaviour
  • social environment

  
• Summary - you should know:

  • basic pathway of nociception
  • how tissue injury gives rise to nociception
  • how nerve injury can drive neuropathic pain
  • how persistent pain may have its cause outside of the body part in which its felt
  • nociception is not pain!
  • psychosocial factors play important mediating role