Glossary

An A-Z guide of the approaches, factors, methods, tools, and techniques that are integral to the KarunaHOME Program.

Treatment Approaches

  • The Biopsychosocial Model is a model of medicine and wellness that is a holistic approach to understanding health and illness that considers biological, psychological, and social factors in the development, progression, and treatment of medical conditions. This model recognizes that health and well-being are influenced by a complex interplay of biological, psychological, and social factors, rather than being solely determined by biological factors alone.

  • CBT is a type of treatment that helps people change their thoughts, feelings, and behavioral patterns. It hinges on the concept that our thoughts and behaviors are linked. By changing our thoughts, we can change our behaviors and thus create positive outcomes in our lives.

  • FABT is a therapeutic approach used in the management of chronic pain, particularly musculoskeletal pain conditions, that is based on the principles of the Fear-Avoidance Model of Pain (FAM). FABT aims to address maladaptive beliefs and behaviors related to pain, fear, and avoidance, and promote adaptive coping strategies and functional recovery. The key components of FABT are psychoeducation, assessment of fear-avoidance beliefs, cognitive reframing of catastrophizing thoughts and pain-related beliefs, graded exposure to feared activities and movements, behavioral activation to resume valued activities and interests, and skills training with such things as relaxation techniques, mindfulness, and stress reduction.

  • A multidisciplinary pain program that involves pain psychology, medication management, exercise, physical therapy exercises.

  • An evidence-based approach to treating chronic pain. GMI is a 'top-down' treatment paradigm and is a series of brain exercises aimed at addressing cortical changes associated with pain and movement dysfunction. Each component targets a different brain area/function. It is commonly used to treat phantom limb pain, complex regional pain syndrome, and neuropathic pain.

    The components are:

    • Laterality recognition: left/right discrimination

    • Explicit Motor Imagery: imagined movements of the affected extremity

    • Mirror therapy: view reflected movement of the unaffected extremity.

    Graded Motor Imagery is a foundation of the KarunaHOME program.

  • An evidence based treatment tool that conceives of every human being as a system of protective and wounded inner parts led by a core Self. It helps people heal by accessing and healing their protective and wounded inner parts.

  • A strategy that aims to teach patients to reshape their mindset and perception of pain despite these factors. It provides patients a better understanding of their condition and motivates them to become active participants in their treatment programs. The ultimate goal for Pain Neuroscience Education (PNE) is to increase pain tolerance with movement (e.g., be able to perform exercise with mild discomfort), reduce any fear associated with movement, and reduce central nervous system hypersensitivity. In practice, this often includes the use of educational pain analogies, re-education of patient misconceptions regarding disease pathogenesis, and guidance about lifestyle and movements modifications that can be introduced.

  • Treatment or alleviation of a medical condition, symptom, or disorder. It encompasses a wide range of interventions, approaches, and modalities aimed at promoting health, restoring function, and improving overall well-being.

Therapeutic Techniques

  • Fundamental skills that are required to independently care for oneself, such as dressing, eating, bathing, and mobility (walking). It is used as an indicator of a person's functional status.

  • A therapeutic technique that involves using electronic monitoring devices to provide real-time information about physiological processes in the body, such as heart rate, muscle tension, skin temperature, and brainwave activity. The goal of biofeedback is to help individuals learn to control and regulate these physiological processes through mental and physical exercises, ultimately improving health, performance, and well-being.

  • A breathing technique that involves contracting the diaphragm muscle to expand the abdomen during inhalation. This can lower the heart rate and blood pressure and promote relaxation.

  • A technique used to help individuals overcome fears, phobias, and anxiety disorders by gradually exposing them to feared stimuli or situations in a controlled and systematic manner. The goal of graded exposure is to reduce fear and anxiety by helping individuals confront their fears in a gradual and structured way, allowing them to build confidence and tolerance over time. This process involves breaking down the feared stimulus or situation into smaller, manageable steps, starting with less anxiety-provoking situations and progressively increasing the level of exposure as the individual becomes more comfortable and confident.

  • A mind–body technique involving the deliberate prompting of mental images to induce a relaxed, focused state with the goal of achieving such varied purposes as managing stress or pain, promoting healing, or enhancing performance. The individual utilizes all of the senses (vision, taste, sound, smell, and touch) to simulate or create the sensory perception.

  • Daily activities that require complex thinking skills, including organizational skills, such as driving, shopping, manging finances, housecleaning and maintenance, communication with others via phone/email, and managing medications.

  • A mental practice and state of being characterized by focused attention, awareness, and non-judgmental acceptance of one's thoughts, emotions, sensations, and surroundings in the present moment.

    Mindfulness involves intentionally directing one's attention to the present moment without dwelling on the past or worrying about the future, and cultivating a sense of openness, curiosity, and compassion towards one's internal experiences and the world around them.

  • MBSR is a structured, evidence-based program developed by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical Center in the 1970s. It integrates mindfulness meditation and mindfulness practices with principles of cognitive-behavioral therapy, yoga, and body awareness to help individuals manage stress, cope with chronic pain, and improve overall well-being.

  • The therapeutic modulation or alteration of nerve activity through various techniques to alleviate symptoms of neurological or neuropsychiatric disorders. It involves the targeted delivery of electrical, magnetic, or chemical stimuli to specific neural circuits or regions of the nervous system to modulate their activity and restore normal function.

  • A system of psychological techniques that retrains the brain to interpret and respond to signals from the body properly, subsequently breaking the cycle of chronic pain.

  • A series of tests designed to provoke or reproduce pain symptoms in order to identify the underlying cause or pathology. These tests are often used when the source of pain is unclear or when specific conditions need to be ruled in or ruled out. The goal is to elicit pain responses that help healthcare providers make accurate diagnoses and develop appropriate treatment plans.

  • Somatic Tracking is a technique used in Pain Reprocessing Therapy (PRT) that helps patients focus on painful sensations through a lens of safety, which can deactivate the pain signal. It's a combination of mindfulness, safety reappraisal, and positive affect induction. Somatic Tracking involves focusing on symptoms without reacting to them and describing them as a curious observer, noticing how they change.

  • Visual Analog Scale (VAS) is a tool used in healthcare to measure subjective characteristics or experiences, such as pain intensity, mood, or symptom severity. It typically consists of a horizontal or vertical line, usually 10 centimeters in length, with verbal descriptors anchored at each end representing the extremes of the characteristic being measured.

Psychological Factors

  • Fear is an intense emotional response to a perceived threat, danger, or harm. It is a fundamental survival mechanism that evolved to protect organisms from potential hazards in their environment. When faced with a threatening situation, fear triggers a cascade of physiological and psychological responses that prepare the individual to react and cope with the perceived danger. While fear is a natural and adaptive response to danger, excessive or irrational fear can become problematic and interfere with daily functioning.

  • A model used to explain the development and maintenance of chronic pain conditions, particularly those associated with musculoskeletal disorders. Proposed by Vlaeyen and Linton in the 1990s, the FAM emphasizes the role of psychological factors, such as fear and avoidance behavior, in perpetuating and exacerbating pain experiences. Interventions based on the FAM focus on addressing maladaptive pain-related beliefs and behaviors, promoting gradual exposure to feared activities, encouraging active coping strategies, and fostering self-efficacy and resilience in managing pain. By addressing the cognitive, emotional, and behavioral components of pain experiences, interventions informed by the Fear-Avoidance Model aim to disrupt the vicious cycle of fear and avoidance, reduce disability, improve function, and enhance quality of life in individuals with chronic pain.

  • The Fear Avoidance Beliefs Questionnaire self-report assessment tool designed to measure fear-avoidance beliefs related to physical activity and work in individuals with musculoskeletal pain, resulting in disability. It based on the Fear-Avoidance Model and measures patients’ fear of pain and consequent avoidance of physical activity because of their fear. It is 16 questions in which a patient rates their agreement with each statement on a 7-point Likert scale. There is a maximum score of 96. A higher score indicates more strongly held fear avoidance beliefs. There are two subscales within the FABQ; the work subscale (FABQw) with 7 questions (maximum score of 42) and the physical activity subscale (FABQpa) with 4 questions (maximum score of 24). The numbers in parentheses below designate which items from the FABQ are included in each subscale.

  • A sensitive sensory state marked by exaggerated behavior to detect a threat condition. It occurs when our natural "fight or flight" instinct goes into overdrive.

  • An excessive, irrational, and debilitating fear of movement or physical activity resulting from a feeling of vulnerability due to painful injury or reinjury. It results in pain related movement patterns.

  • It is generally defined as the tendency to magnify the threat and interpretation of pain. It is comprised of three dimensions: rumination, the repetitive focus on symptoms of distress; magnification, an exaggerated perception and anticipation of the threat of pain; and helplessness, a perceived inability to exert control. Pain catastrophizing can have significant implications for pain perception, emotional well-being, and functional outcomes. Research suggests that individuals who engage in pain catastrophizing may experience more intense pain, greater disability, increased psychological distress, and poorer treatment outcomes compared to those who do not catastrophize.

  • PCS is a 13-item self-report measure designed to assess catastrophic thinking related to pain among adults with or without chronic pain. Higher scores indicate a greater degree of pain catastrophizing. A total score of >30 represents a clinically significant level of pain catastrophization. It was developed to help quantify an individual's pain experience, asking about how they feel and what they think about when they are in pain.

Anatomy and Physiology

  • The movement of a body part away from the midline of the body or the centerline of a limb.

  • The movement of a body part toward the midline of the body or the centerline of a limb. It is the opposite of abduction, which involves moving a body part away from the midline.

  • The Autonomic Nervous System is a body system that regulates involuntary physiologic processes, including heart rate, blood pressure, respiration, digestion, and sexual arousal. It consists of two main branches: the sympathetic nervous system (SNS), often associated with the "fight or flight" response, and the parasympathetic nervous system (PNS), associated with the "rest and digest" response.

  • The Cervical Spine (or C-Spine) is located in the neck region between the skull and the thoracic spine. It consists of seven vertebrae, labeled C1 to C7.

  • Chronic pain is a persistent and often debilitating condition characterized by pain that lasts for an extended period, typically more than three to six months, beyond the normal time for healing. Unlike acute pain, which serves as a warning signal of injury or tissue damage, chronic pain persists long after the initial injury has healed and may not have an identifiable cause or origin.

  • CRPS is a chronic pain condition characterized by severe and persistent pain, usually affecting one limb (arm, leg, hand, or foot), though it can spread to other parts of the body over time. CRPS typically occurs following a traumatic injury, surgery, or other medical condition that affects the nerves or musculoskeletal system, although in some cases, the condition may arise without an identifiable trigger. It was formerly known as Reflex Sympathetic Dystrophy (RSD).

  • The movement that increases the angle between two body parts or straightens a joint, typically moving a body part backward or away from the midline of the body.

  • The movement that decreases the angle between two body parts or bends a joint, typically moving a body part forward or towards the midline of the body.

  • Also known as the lower back or lumbosacral spine, is the region of the vertebral column located between the thoracic spine (upper back) and the sacrum (pelvis). It consists of five vertebrae, designated as L1 to L5.

  • Neural circuit pain, also known as central sensitization, is a type of chronic pain characterized by alterations in the processing of pain signals within the central nervous system (CNS), particularly in the spinal cord and brain. When an injury occurs, the brain develops neural circuits to process the pain experience. These circuits encode, store, and transfer pain information across brain regions. Neural circuit pain arises from dysfunction in the neural circuits that process and modulate pain signals.

  • Neuroplasticity (also known as “neural plasticity” or “brain plasticity”) is the brain's ability to change, adapt, reorganize, and form neural networks/pathways in response to learning from an experience or injury.

  • A type of pain that arises from actual or threatened damage to tissue and is due to the activation of nociceptors, which are specialized sensory receptors that respond to potentially damaging stimuli by sending signals to the brain.

  • According to the International Association for the Study of Pain (IASP), the 2020 updated definition is "An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage".

  • The Parasympathetic Nervous System (PNS) is one of the two divisions of the autonomic nervous system, which regulates involuntary bodily functions such as heart rate, digestion, and respiratory rate. It works in opposition to the sympathetic nervous system, with both systems often acting together to maintain homeostasis in the body.

  • Predictive Coding is a theory that says the brain is always building and refining its representations or models of the outside world and out bodies. Our perceptions depend in large part on these models not just our incoming sensory data.

  • Range of Motion (ROM) is the extent of movement that occurs at a specific joint or group of joints in the body. It is a measurement used to assess flexibility, mobility, and functional ability in individuals and is important for activities of daily living, sports performance, and rehabilitation.

  • Scaption is the movement of a body part toward the midline of the body or the centerline of a limb. It is the opposite of abduction, which involves moving a body part away from the midline. the arms are elevated at an angle of approximately 30 to 45 degrees away from the midline of the body, with the palms facing each other or slightly turned inward.

  • The Sympathetic Nervous System (SNS) is one of the two divisions of the Autonomic Nervous System (ANS), along with the Parasympathetic Nervous System (PNS). These systems primarily work unconsciously in opposite ways to regulate many functions and parts of the body. The SNS governs the "fight or flight" response. The main overall end effect of the SNS is to prepare the body for physical activity, a whole-body reaction affecting many organ systems throughout the body to redirect oxygen-rich blood to areas of the body needed during intense physical demand.

Healthcare Systems and Practices

  • Medical devices, equipment, supplies, and assistive devices that are prescribed by a healthcare provider for use by patients with medical conditions or disabilities. DME is designed to provide therapeutic benefits, support mobility, improve function, or assist with activities of daily living for individuals with physical or medical limitations.

  • A federal law enacted in 1996 in the United States designed to improve the efficiency and effectiveness of the healthcare system while safeguarding the privacy and security of individuals' protected health information (PHI).

  • A Multidisciplinary Approach is a holistic, coordinated, patient-centered approach using a team of healthcare providers with different specialties for a comprehensive care plan.

  • National Board Certified Health & Wellness Coaches (NBC-HWC) support clients in activating internal strengths and external resources to make sustainable and healthy lifestyle behavior changes. They use a client-centered approach wherein clients decide their goals, engage in self-discovery or active learning processes, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a health coach.

    All KarunaHOME Coaches are required to have the NBC-HWC certification.

  • Remote Patient Monitoring (RPM) is a healthcare delivery model that uses technology to monitor patients outside of traditional healthcare settings, such as hospitals or clinics. It involves the collection, transmission, and analysis of patient health data from a distance, allowing healthcare providers to remotely monitor patients' health status and intervene as needed.

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