CMT CMT Pain Science & Patient Education 1 — Questions and Answers
Question 1: According to the gate control theory of pain, manual therapy techniques may reduce pain by:
- Completely blocking nociceptor activation in peripheral tissue
- Activating large-diameter Aβ afferents that inhibit nociceptive transmission at the spinal cord level (Correct answer)
- Permanently altering central sensitization pathways
- Releasing endorphins from the pituitary gland only
Correct answer: Activating large-diameter Aβ afferents that inhibit nociceptive transmission at the spinal cord level
Gate control theory proposes that mechanoreceptor input (Aβ fibers) can inhibit nociceptive signals (Aδ/C fibers) at the spinal dorsal horn 'gate.'
Question 2: Central sensitization is best described as:
- Increased sensitivity of peripheral nociceptors at the injury site
- Amplification of neural signaling within the central nervous system, causing hypersensitivity beyond the original injury (Correct answer)
- A normal healing response that resolves within 6 weeks
- Sensitivity to centrally acting analgesics only
Correct answer: Amplification of neural signaling within the central nervous system, causing hypersensitivity beyond the original injury
Central sensitization involves CNS neuroplastic changes that amplify pain signals, producing allodynia and hyperalgesia beyond the tissue injury.
Question 3: In pain neuroscience education (PNE), the primary goal of educating patients about pain is to:
- Convince patients that their pain is not real
- Reduce pain catastrophizing by reconceptualizing pain as a protective brain output rather than a tissue damage signal (Correct answer)
- Replace all manual therapy with education only
- Increase patient awareness of structural damage causing their pain
Correct answer: Reduce pain catastrophizing by reconceptualizing pain as a protective brain output rather than a tissue damage signal
PNE reconceptualizes pain as a protective output of the brain rather than purely a signal of tissue damage, reducing fear-avoidance and catastrophizing.
Question 4: Allodynia is defined as:
- Increased pain response to a normally painful stimulus
- Pain produced by a stimulus that would not normally be painful (Correct answer)
- Complete absence of pain sensation in an injured area
- Pain referred to a distant site from the injury
Correct answer: Pain produced by a stimulus that would not normally be painful
Allodynia is pain in response to a normally non-painful stimulus (e.g., light touch causing pain), indicating sensitization of the pain system.
Question 5: The biopsychosocial model of pain recognizes that chronic pain is influenced by:
- Biological tissue damage alone
- Biological factors, psychological factors (beliefs, mood), and social factors (work, relationships) (Correct answer)
- Psychological factors exclusively
- Radiographic findings and inflammatory biomarkers only
Correct answer: Biological factors, psychological factors (beliefs, mood), and social factors (work, relationships)
The biopsychosocial model integrates biological, psychological, and social factors as simultaneous and interacting contributors to the pain experience.
Question 6: The Fear-Avoidance Model of pain predicts that patients with high pain catastrophizing will:
- Recover quickly through increased activity
- Develop activity avoidance, leading to deconditioning and prolonged disability (Correct answer)
- Have less severe pain due to psychological distraction
- Be more compliant with home exercise programs
Correct answer: Develop activity avoidance, leading to deconditioning and prolonged disability
High catastrophizing leads to fear of movement (kinesiophobia), avoidance of activity, deconditioning, and a cycle of increasing pain and disability.
CMT CMT Pain Science & Patient Education 1
According to the gate control theory of pain, manual therapy techniques may reduce pain by: