CMT CMT Pain Science & Patient Education 2 — Questions and Answers
Question 1: Hyperalgesia differs from allodynia in that hyperalgesia involves:
- Pain from non-painful stimuli
- An exaggerated pain response to a stimulus that is normally mildly painful (Correct answer)
- Complete loss of pain sensation
- Pain only during movement, not at rest
Correct answer: An exaggerated pain response to a stimulus that is normally mildly painful
Hyperalgesia is an increased pain response to a stimulus that would normally cause mild pain, whereas allodynia is pain from a non-painful stimulus.
Question 2: When educating a patient with chronic low back pain, a CMT should emphasize that:
- Pain always equals structural tissue damage and should be avoided
- Pain is a reliable indicator of spinal instability requiring surgery
- Movement is generally safe and pain does not always mean harm (hurt ≠ harm) (Correct answer)
- Bed rest is recommended until pain reaches zero
Correct answer: Movement is generally safe and pain does not always mean harm (hurt ≠ harm)
A core PNE message is 'hurt does not equal harm' — movement is generally safe for chronic pain and avoidance perpetuates disability.
Question 3: Endogenous pain inhibition (descending modulation) is primarily mediated by which neurotransmitters?
- Substance P and glutamate
- Serotonin, norepinephrine, and endogenous opioids (Correct answer)
- Histamine and bradykinin
- Acetylcholine and dopamine exclusively
Correct answer: Serotonin, norepinephrine, and endogenous opioids
Descending pain inhibitory pathways use serotonin, norepinephrine, and endogenous opioids (enkephalins, endorphins) to modulate spinal nociception.
Question 4: Which psychological factor is most strongly associated with poor chronic pain outcomes in research?
- Mild anxiety about diagnosis
- Pain catastrophizing — rumination, magnification, and helplessness about pain (Correct answer)
- A preference for passive treatments
- Normal grief response to an activity limitation
Correct answer: Pain catastrophizing — rumination, magnification, and helplessness about pain
Pain catastrophizing (ruminating on pain, magnifying its threat, feeling helpless) is consistently the strongest psychological predictor of poor pain outcomes.
Question 5: The Tampa Scale of Kinesiophobia (TSK) measures:
- Overall depression and anxiety levels
- Fear of movement and re-injury in musculoskeletal pain patients (Correct answer)
- Patient satisfaction with manual therapy outcomes
- Functional capacity for return to work
Correct answer: Fear of movement and re-injury in musculoskeletal pain patients
The TSK is a validated 17-item questionnaire measuring fear of movement and re-injury (kinesiophobia) in musculoskeletal pain populations.
Question 6: A CMT identifies yellow flags in a patient history to recognize:
- Absolute contraindications to manual therapy
- Serious pathology requiring immediate medical referral
- Psychosocial risk factors for chronicity and disability (Correct answer)
- Signs of infection or malignancy
Correct answer: Psychosocial risk factors for chronicity and disability
Yellow flags are psychosocial factors (beliefs, behaviors, emotions, social context) that increase the risk of developing chronic pain and disability.
CMT CMT Pain Science & Patient Education 2
Hyperalgesia differs from allodynia in that hyperalgesia involves: