Identifying Data 2023/24
Subject (*) Multidisciplinary Approach in Pain: Neurobiology, Pain and Disability, Evaluation Systems, New Parad Code 651516006
Study programme
Mestrado Universitario en Discapacidade e Dependencia (plan 2015)
Descriptors Cycle Period Year Type Credits
Official Master's Degree 2nd four-month period
 First Optional 6
Language
Spanish
Teaching method Face-to-face
Prerequisites
Department Fisioterapia, Medicina e Ciencias Biomédicas
Coordinador
Rodriguez Romero, Beatriz
 E-mail
beatriz.romero@udc.es
Lecturers
Patiño Nuñez, Sergio
Rodriguez Romero, Beatriz
Souto Gestal, Antonio
 E-mail
sergio.patino@udc.es
beatriz.romero@udc.es
antonio.souto@udc.es
Web
General description En esta asignatura se profundiza en los aspectos neurobiológicos del dolor crónico; se revisan los conceptos actuales sobre la fisiopatología del dolor más relevantes en su manejo clínico; se estudian las implicaciones del dolor, especialmente, en la esfera sensitiva y motora; y se analizan las diferentes pruebas de valoración y las estrategias de tratamiento del dolor crónico más actuales y basados en la evidencia disponible.

Study programme competencies
Code Study programme competences
A8 CERF3. Ser capaces de entender a fisiopatoloxía da dor relevante na práctica clínica así como as súas implicacións dende un punto de vista sensitivo-perceptivo-motora
A9 CERF4. Capacidade para deseñar e executar proxectos de investigación na problemática bio-psico-social da dor
B1 CB6. Posuír e comprender coñecementos que acheguen unha base ou oportunidade de ser orixinais no desenvolvemento e/ou aplicación de ideas, a miúdo nun contexto de investigación
B7 CG2 Identificar, avaliar e resolver os problemas derivados da presenza de discapacidade e dependencia
B9 CG4 Ser capaz de intervir na problemática derivada da discapacidade e da dependencia
B10 CG5 Capacidade para integrar coñecementos científicos de carácter avanzado ligados ao ámbito da discapacidade e a dependencia
C6 CT6. Valorar críticamente o coñecemento, a tecnoloxía e a información dispoñible para resolver os problemas aos que deben enfrontarse
C7 CT7. Ser capaz de valorar a importancia que ten a investigación, a innovación e o desenvolvemento tecnolóxico no avance socioeconómico e cultural da sociedade?

Learning aims
Learning outcomes Study programme competences
To describe the clinical and socioeconomic impact of chronic pain. AR9
 BR1
 CR6
To delve into the neurobiological aspects of pain. AR8
 BR1
BR10
 CR6
To compare the paradigms used to explain pain. AR8
AR9
 BR10
 CR7
To identify the characteristics and clinical manifestations of different types of pain. AR8
 BR7
BR9
To review the current concepts on the physiopathology of pain to clinical management. AR8
AR9
 BR1
BR7
BR9
To study the implications of pain from a sensitive-perceptive-motor point of view. AR8
 BR7
BR9
BR10
To identify the common characteristics of chronic pain syndromes. BR1
BR7
BR9
BR10
To review and be able to apply different pain assessment tests. AR9
 BR1
BR7
BR9
 CR7
To analyze new strategies for the treatment of chronic pain, to study its evidence and to know the recommendations for its use in clinical practice. AR9
 BR1
BR7
BR9
BR10
 CR6
CR7

Contents
Topic Sub-topic
1. Epidemiology of pain 1.1. Epidemiology of musculoskeletal pain. Basic concepts.
1.2. Epidemiology of low back pain
1.3. Epidemiology of cervical pain
1.4. Epidemiology of osteoarthritis
1.5. Epidemiology of chronic widespread pain and fibromyalgia
2. Paradigms in pain management: pain as a multidimensional experience 2.1. Pathoanatomical model
2.2. Biopsychosocial model
2.3. Model of the neuromatrix
3. Neurobiological aspects of pain 3.1. Definitions of pain
3.2. Characteristics and clinical manifestations of pain
3.3. Cellular and molecular properties of primary afferent neurons
3.4. Inflammatory mediators and pain modulators
3.5. Mechanisms modulating the painful response: neuroplasticity
3.6. Brain and pain
3.7. Genetics and pain
4. Pathophysiology of chronic pain 4.1. Definition of the phenomenon of centralization
4.2. Wind-up phenomenon
4.3. Changes in neurotransmitters
4.4. Functional alteration of excitatory and inhibitory connections
4.5. Creation of new connections
4.6. Supraspinal neuroplastic changes: reorganization of somatosensory and motor cortical maps
4.7. Modification of the response pattern of cortical and subcortical areas
4.8. Impact of emotional and cognitive-behavioral factors
4.9. Pain as a multisystem response: involvement of the SNA, neuroendocrine and immune
5. Chronic pain syndromes 5.1. Fibromyalgia
5.2. Chronic Fatigue Syndrome
5.3. Complex regional syndrome type I
5.4. Others
6. Pain assessment methods 6.1. Clinic history
6.2. Scales of pain intensity measurement
6.3. Scales to measure "yellow flags"
6.4. Scales of functional disability
6.5. Quality of Life Scales Related to Health
6.6. Other scales of measurement
6.7. Physical tests
7. Analysis and review of the evidence on new pain treatment strategies 7.1. Pain pedagogy
7.2. Therapeutic exercise
7.3. Gradual motor imagination
7.4. Other methods

Planning
Methodologies / tests Competencies Ordinary class hours Student’s personal work hours Total hours
Introductory activities C7 0 2 2
Guest lecture / keynote speech A8 A9 B1 B7 B9 B10 C6 C7 18 36 54
Seminar A8 B1 B7 B9 B10 0 25 25
Document analysis A8 A9 B1 B9 B10 C6 C7 0 25 25
Directed discussion B1 C6 C7 4 12 16
Multiple-choice questions A8 B1 B9 B10 1 21 22
 
Personalized attention 6 0 6
 
(*)The information in the planning table is for guidance only and does not take into account the heterogeneity of the students.

Methodologies
Methodologies Description
Introductory activities The study programme competencies, learning aims, contents, planning, methodologies, personalized attention and assessment will be presented. The student will be given the possibility of sending the coordinator the interests and motivations related to the subject in order to facilitate the learning proces
Guest lecture / keynote speech The magisterial sessions correspond to two types of classes: (i) the face-to-face theoretical classes taught in the classroom; (ii) to the asynchronous classes that will be delivered to students in various formats (video-lessons, notes in pdf format, etc.) and that will be posted in Moodle. They will be intended primarily for the purposes of knowledge or knowledge.
It will be primarily intended for the purposes of knowledge.
Seminar Group work technique aimed at the intensive study of a subject. It is characterised by discussion, participation, and the preparation of documents and conclusions to be reached by all members of the seminar.
Document analysis (i) Search and analysis of multimedia documents (blogs, videos, web page, Twitter accounts, etc.) relevant to the subject.

(ii) From an article related to the subject, the metric characteristics of its publication journal, and an analysis of the different sections of the article will be analyzed. In addition, a search for 2 articles published in the last 5 years related to the topic of such article and a general summary of each of them will be added.
Directed discussion Through this technique of group dynamics, students will freely discuss a topic previously selected by one of the teachers. Students will be coordinated by a moderator.
Multiple-choice questions The exam will consist of 30 simple choice questions, where each 2 incorrect answers will subtract 1 right answered one. The exam will have a value of 40% of the total mark of the subject.

Personalized attention
Methodologies
Seminar
Multiple-choice questions
Directed discussion
Guest lecture / keynote speech
Document analysis
Description
The personalised attention will realise face-to-face form and through the platform Microsoft Teams, Virtual Campus and email; and it will be able to adapt to different modalities and contexts:

- Through tutorías, specifically requested by the/the student/the or subgroup of students/the, the students will be able to resolve questions to any one of the teaching guide´s steps.

- During the two methodologies of work grupal the student will receive feedback of the execution of such tasks, and will be able to resolve the doubts .

- Through the Virtual Campus, will create a forum of doubts for each subject where the students can launch his questions and/or establish debate between professor/students or between the students.

*For the students with recognition of dedication part time and dispenses academician of exemption of assistance, each student has to contact with the coordinator of the matter to the start of the course to establish the modality of preferential personalised attention; and fix to the start of course the possible adaptations of the tasks.

Assessment
Methodologies Competencies Description Qualification
Seminar A8 B1 B7 B9 B10 The student's ability to carry out the process of discussion, participation and elaboration of conclusions related to the study of a topic is assessed. 20
Multiple-choice questions A8 B1 B9 B10 Multiple choice test with a total of 30 questions. Every 2 wrong answers will subtract one right.

 40
Directed discussion B1 C6 C7 Attendance and active participation in the two scheduled face-to-face sessions are evaluated. 20
Document analysis A8 A9 B1 B9 B10 C6 C7 The student's ability to carry out the clinical reasoning process on real or fictitious cases is evaluated, as well as the discussion on their proposed solution, by answering the questions asked about such cases. 20
 
Assessment comments

The evaluation criteria will be maintained for all the summons of the academic course.

In the case of plagiarism by the student, the following criteria will be applied: "Failure grade in the term in which the offence is committed and with respect to the subject in which it is committed: the student will be graded with a "fail" (numerical grade 0) in the corresponding term of the academic year, whether the offence is committed at the first opportunity or at the second opportunity. To this end, the student's grade will be modified in the first opportunity report, if necessary.

Sources of information
Basic Kosek, E., Clauw, D., Nijs, J., Baron, R., Gilron, I., Harris, R. E., ... & Sterling, M. (2021). Chronic nociplastic pain affecting the musculoskeletal system: Clinical criteria and grading system. . Pain, 162(11), 2629-2634.
Butler D (2010). Explicando el dolor. Adelaida, Australia: Noigroup
Nijs, J., Van Houdenhove, B. (2009). From acute musloskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice. Manual Therapy
Iannetti, G.D., Mouraux, A. (2010). From the neuromatrix to the pain matrix (and back). Exp Brain Res
Basbaum, A.I. & Jessell, T.M. (2013). Pain, (pp. 530-555). En E.R. Kandel et al. (Eds.). Principles of neural science.. New York: McGraw-Hill.
Enriquez-Blanco, H., Schneider, R., Rodríguez, J. T. (2010). Síndrome del intestino irritable y otros trastornos relacionados.. Madrid: Panamericana
Serra Catafau J. (2007). Tratado de dolor neuropático. Madrid: Médica Panamericana
Sengupta, J.N. (2009). Visceral Pain: the neurophysiological mechanism. Handb Exp Pharmacol
Stephen B. McMahon, Martin Koltzenburg (2006). Wall y Melzack tratado del dolor. Madrid: Elsevier. 5ª ed.

Complementary


Recommendations
Subjects that it is recommended to have taken before

Subjects that are recommended to be taken simultaneously

Subjects that continue the syllabus

Other comments

To help achieve a sustainable environment and meet the strategic objectives of the Green Campus Plan of the Faculty of Physiotherapy, the documentary work carried out in this subject may be requested in paper or virtual format or computer support. If they are done on paper, the following general recommendations will be followed as far as possible:

- Plastics will not be used.

- Double-sided prints will be made.

- Recycled paper will be used.

- Drafting will be avoided.


(*)The teaching guide is the document in which the URV publishes the information about all its courses. It is a public document and cannot be modified. Only in exceptional cases can it be revised by the competent agent or duly revised so that it is in line with current legislation.