central sensitization pain in physical therapy practice around the world PDF
Preview central sensitization pain in physical therapy practice around the world
29-6-2017 CENTRAL SENSITIZATION PAIN IN PHYSICAL THERAPY PRACTICE AROUND THE WORLD http://www.wcpt.org/wcpt2017/COURSE-11 CENTRAL SENSITIZATION PAIN IN PHYSICAL THERAPY PRACTICE AROUND THE WORLD http://www.wcpt.org/wcpt2017/COURSE-11 1 29-6-2017 Romy Parker • Associate Professor University of Cape Town • Director of Train Pain Academy www.trainpainacademy.co.za • chronic pain management team Groote Schuur Hospital • President-elect of PainSA • Chair of the Pain, Mind and Movement Special Interest Group of IASP CENTRAL SENSITIZATION PAIN IN PHYSICAL THERAPY PRACTICE AROUND THE WORLD http://www.wcpt.org/wcpt2017/COURSE-11 2 29-6-2017 Michele Sterling • Professor Griffith University • Director NHMRC Centre of Research Excellence in Road Traffic Injury • Chair Scientific Program Committee Australian Pain Society • ranked #1 whiplash injury researcher in the world www.expertscape.com • > $13M competitive research funding • > 150 scientific papers CENTRAL SENSITIZATION PAIN IN PHYSICAL THERAPY PRACTICE AROUND THE WORLD http://www.wcpt.org/wcpt2017/COURSE-11 3 29-6-2017 Kelly Ickmans • Visiting & research professor • Postdoctoral researcher • PT - clinician • Pain in Motion kids • PhD supervisor • > 30 papers Medical diagnosis Medical discipline Estimated % predominant central sensitizationpain Low back pain Orthopedics 25% Pediatricpain Pediatrics ? Post-cancerpain Oncology 11% Osteoarthritis Rheumatology 30% Whiplashassociateddisorders Emergencymedicine 90% Nontraumaticneckpain Physicalmedicine 10% Shoulderpain Physicalmedicine 10% Fibromyalgia Rheumatology 100% 4 29-6-2017 Medical diagnosis Medical discipline Estimated % predominant central sensitizationpain Low back pain Orthopedics 25% Pediatricpain Pediatrics ? Post-cancerpain Oncology 15% Osteoarthritis Rheumatology 30% Whiplashassociateddisorders Emergencymedicine 90% Nontraumaticneckpain Physicalmedicine 10% Shoulderpain Physicalmedicine 10% Fibromyalgia Rheumatology 100% Medical diagnosis Medical discipline Estimated % predominant central sensitizationpain Low back pain Orthopedics 25% Pediatricpain Pediatrics ? Post-cancerpain Oncology 15% Osteoarthritis Rheumatology 30% Whiplashassociateddisorders Emergencymedicine 90% Nontraumaticneckpain Physicalmedicine 10% Shoulderpain Physicalmedicine 10% Fibromyalgia Rheumatology 100% 5 29-6-2017 Content overview • Introduction • Central sensitization: maladaptive neuroplasticity in patients with chronic pain (Kelly) • Neuropathic central sensitization pain in physical therapy practice: HIV- related neuropathic pain as an example (Romy) • Neuropathic central sensitization pain in physical therapy practice: assessment (Romy & Michele) • Non-neuropathic central sensitization pain in physical therapy practice: Neck pain as an example (Michele & Jo) • Non-neuropathic central sensitization pain in physical therapy practice: case study (Kelly & Jo) Content overview • Introduction • Central sensitization: maladaptive neuroplasticity in patients with chronic pain (Kelly) • Neuropathic central sensitization pain in physical therapy practice: HIV- related neuropathic pain as an example (Romy) • Neuropathic central sensitization pain in physical therapy practice: assessment (Romy & Michele) • Non-neuropathic central sensitization pain in physical therapy practice: Neck pain as an example (Michele & Jo) • Non-neuropathic central sensitization pain in physical therapy practice: case study (Kelly & Jo) 6 29-6-2017 Pain Nociceptors Nociceptiveneurons andWDR neurons in DH Thalamus Corticalregions Corticaloutput 13 Nociceptive pain Inflammation Tissue injury Growingmass … distension rupture stimulationmech. receptors activationnociceptors 14 7 29-6-2017 ↓ threshold Nerve PrimaryHYPERALGESIA ↑ firingrate impulses↑↑ ALLODYNIA 15 Why? Primary hyperalgesia = adaptive response of the nervous system, preventing further damage and hence facilitating tissue healing. 16 8 29-6-2017 Nociception vs. pain • There’s a direct link between the amount of tissue damageandthelevelofpainexperienced • All pain is caused by injury and increased pain means moredamage • Painiseitherphysicalorpsychological • In chronicpaintissues didnot healand damage is still ongoing • Nociceptionandpainaresynonyms 17 • There’s a direct link between the amount of tissue damage and the level of pain experienced(patientstrulybelievethis!) • All pain is caused by injury and increased painmeansmoredamage • Painiseitherphysicalorpsychological • In chronic pain tissues did not heal and damageisstillongoing • Nociceptionandpainaresynonyms 18 9 29-6-2017 Pain vs. Nociception 19 Nociception ≠ Pain & Pain ≠ Nociception 20 10
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