New York Physical Therapy Ebook Continuing Education

measure psychosocial factors related to central sensitization and headache symptoms (Nishigami et al., 2018). Nishigami et al. (2018) developed a short form of the central sensitization inventory for use with patients with musculoskeletal pain. Statistical analysis was used to shorten the inventory to nine questions while maintaining the integrity and purpose of the test. The items remaining are as follows: 1. I feel unrefreshed when I wake up in the morning.

Patients with chronic headaches have been shown to exhibit central sensitization as detected by various methods (Filatova et al., 2008). The biopsychological model of pain and the concept of central sensitization make evaluation of the patient with chronic headache much more complex for the physical therapist. Training in pain neuroscience, which encompasses the biopsychosocial model of pain and the concept of central sensitization, is an important part of effective evaluation and treatment of patients with headaches. It is the perspective of the author that clinicians with the highest level of education in neuroscience, the highest levels of compassion for their patients, and the highest levels of understanding regarding each patient’s personhood and past are best able to use their skills and knowledge to effectively help clients with headaches and The Central Sensitization Inventory has been developed for the purpose of assessing the dimensions of central sensitization and quantifying the degree of central sensitization symptoms. The test consists of two parts. Part A consists of 25 items and is an inventory of presenting symptoms. Some of the items include: symptoms of central sensitization. Assessing central sensitization

2. My muscles feel stiff and achy. 3. I feel pain all over my body. 4. I have headaches. 5. I do not sleep well. 6. I have difficulty concentrating.

7. Stress makes my physical symptoms get worse. 8. I have muscle tension in my neck and shoulders. 9. I have difficulty remembering things.

Even without using a specific central sensitization inventory, clinicians who are aware of the above list of central sensitization symptoms can ask about and/or listen for this information as a means of informally assessing the presence of central sensitization. This provide a deeper understanding of the patient and their symptoms and help the clinician develop a more effective treatment plan. Healthcare consideration: When assessing for central sensitization, it is important to avoid thinking that the patient’s pain “is all in their head.” Neurologically, maladaptive coping strategies can influence the central nervous system, in essence “priming” the pump to create neurological hypersensitivity. The consequence of this neurological activity is to create symptoms such as increased response to sensory inputs. Clinicians should understand that maladaptive cognitive coping strategies actually influence and change the nervous system. Healthcare consideration: Differential diagnosis of headache type is critical. It helps you understand the client’s clinical picture, and it dictates treatment approach. One thing that makes differential diagnosis difficult is the fact that there is significant overlap in symptoms between different headache types. It is important for clinicians to know the International Classification of Headache Disorder criteria for each type of headache. In addition, it is important to be familiar with headache red flags. This will help the clinician arrive at the most accurate headache diagnosis. A study by Dale et al. (2020) investigated the decision-making processes of physical therapists relating to evaluation and categorization of patients with headaches. The study used an online survey with three hypothetical patients with headache case vignettes. The goal was to see how accurately the therapists could classify headache types according to the International Headache Society categories. The tension-type headache case was classified correctly by 32.3% of the therapists, the migraine was classified correctly by 41.7% of the therapists, and the cervicogenic headache case was classified correctly by 54.8% of the therapists. Years of clinical experience and formal manual therapy training were associated with improved consistency. Since effective education and treatment are based on an accurate diagnosis, differential diagnosis of these headache types is important. Migraine headaches Migraine headaches are considered the second leading cause of disability worldwide (de Almeida Tolentino et al., 2021). This type of headache generally begins in childhood to early adulthood, although they can first occur in someone beyond 50 years of age, most commonly in perimenopausal and

● I am unrefreshed when I wake up in the morning. ● I get tired very easily when I am physically active. ● I feel pain all over my body. ● I have low energy. ● I have muscle tension in my neck and shoulders.

The second part of the inventory is a list of diagnoses that the patient has been given by a medical provider. These include restless legs syndrome, chronic fatigue syndrome, fibromyalgia, and migraine or tension headaches. This tool has been shown to help identify patients whose presenting medical issues may be comorbid with symptoms of central sensitization (Mayer et al., 2012). It can be a useful tool for physical therapists treating headache patients, as central sensitization can be a significant contributor to chronic headaches. In particular, it can help Differentiating common headache types Once medical history, clinical presentation, pain pattern, and psychosocial factors have been thoroughly reviewed and addressed, the next step in differential diagnosis is determining what type of headache is present. The International Classification of Headache Disorders (ICHD-III) presents headache diagnoses in a hierarchical fashion, with migraine as the first consideration, tension-type headaches as the second, and cervicogenic headaches as the third (Fernandiz-de-las-Penas et al., 2020). These three types of headaches are commonly treated with nonpharmacological interventions, with manual therapy being the most common nonmedical treatment requested by patients (Fenandiz-de-las-Penas et al., 2020). Consequently, physical therapists often evaluate and treat these types of patients. There is significant overlap in symptomatology and clinical presentation between these headache types, which makes accurate diagnosis difficult. In addition, according to Dale et al. (2020), headaches of different etiology have been shown to exhibit central sensitization, where the stimulus needed to generate a headache decreases over time, while the amplitude of the response to having a headache increases (Filatova et al., 2008). This results in tenderness to palpation, lowered pain thresholds, mechanical allodynia, and hyperalgesia. Thus, a finding such as tenderness in the upper cervical spine may contribute little to accurate diagnosis (Dale et al., 2020).

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Book Code: PTNY1024 Physical-Therapy

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