Assessment of Pain Exam 1 Flashcards
What does the OPQRSTU mnemonic stand for?
- O - Onset
- P - Provocative/Palliative
- Q - Quality/Character
- R - Region/Radiation
- S - Severity
- T - Timing/Treatment
- U - You/Impact
This is a tool to identify pain characteristics in an interview.
What are considered ‘red flags’ in pain assessment?
- Bowel/bladder dysfunction
- Saddle anesthesia
- Bilateral leg weakness
- Severe, sudden onset headache
- Fever, weight loss, night sweats
- Recent injury
- History of cancer
What is the significance of the STOP-BANG screening tool?
It assesses the risk of obstructive sleep apnea
S Snoring?
T Tired?
O Observed apnea?
P High Blood Pressure?
B BMI > 35?
A Age > 50?
N Neck circumference > 40 cm (16 inches)?
G Gender is male?
Score of 3 or more = OSA 93%, 100% moderate to severe OSA
What should be assessed to determine effectiveness of your treatment?
- Activity
- Analgesia
- Aberrant drug-related behavior
- Adverse effects
- Affect
- Adjuncts
What is ORT? What questions does it ask?
Opioid Risk Tool
1. Family and personal history of substance abuse
2. Hx of sexual abuse
3. Psychiatric disorder
0-3: low risk
4-7: moderate risk
> 8: high risk
What is cauda equina syndrome?
Compression of the lumbosacral nerve roots in the spinal chord (L2-sacrum)
s/s: saddle anesthesia, assymetric pain/paralysis, areflexic lower extremities
What is conus medullaris?
Injury of sacral cord segment (L1-L2) (Higher than cauda equina)
Usually not severe
s/s: similar to cauda equina but symmetric symptoms, may involve reflexes and sphincter tone
What is the definition of acute neck pain?
Pain present for less than 3 months
What are common risk factors for chronic neck pain?
- Stress at work
- Previous injuries
- Litigation
What distinguishes radiating neck pain from referring neck pain?
Radiating pain follows dermatomes and has an abnormal neurological exam;
referring pain follows myotomes and typically has a normal neurological exam.
What is the prognosis for acute low back pain?
Favorable; 80% can expect to recover rapidly
What is the definition of chronic neck pain?
Pain present for more than 3 months
How do we diagnose and assess the severity of fibromyalgia?
- widespread pain index (WPI) (0-19)
- symptom severity (SS) score (0-12)
WPI ≥7 and SS ≥5 or
WPI 3 - 6 and SS scale score ≥9.
What should be done if neck pain persists despite treatment?
Perform an MRI to detect an occult lesion and order an image-guided diagnostic test.
What is the role of countertransference in interviewing patients with chronic pain?
It can elicit an emotional response and provide insight into the patient’s situation.
What is the key focus of a patient-centered interview?
Building trust and understanding the patient’s perspective
What is the significance of imaging in the absence of red flag signs?
Routine imaging may reinforce sick behavior and worsen long-term outcomes.
What is the clinical indicator for ordering an X-ray?
Severe trauma
What does the term ‘myofascial pain’ refer to?
Pain originating from muscle and fascia
What is the definition of nociceptive pain?
Pain caused by damage to body tissue
What are common psychiatric comorbidities associated with chronic pain?
- Depression
- Anxiety
- ADHD
- Substance use
- PTSD
What is the first line imaging for suspected stress fractures?
X-ray
What imaging methods are used for assessing osteomyelitis?
Bone scan or MRI
List some risk factors for infection.
- Invasive medical procedure
- Injection
- Illicit drug use
- Trauma to skin or mucous membrane
- Immunosuppression
- Diabetes mellitus
- Alcoholism
What are the common symptoms indicating a possible tumor?
- Past history of malignancy
- Age greater than 50
- Failure to improve
- Weight loss
- Pain not relieved by rest
Which imaging is preferred for diagnosing an aortic aneurysm?
Ultrasound
What are the most common shoulder pain conditions?
- Rotator cuff impingement or tear
- Gleno-humeral / sub-acromial bursitis
- Gleno-humeral instability
- Bicep tendonitis
What tests are used to identify biceps tendonitis?
- Speed’s and Yerguson tests with elbow flexion
What tests are used to identify rotator cuff injury?
- Apley scratch test: pain when reaching to opposite scapula
- Neers test: pain with shoulder flexion
- Hawkin’s test: pain with shoulder internal rotation
- Drop arm test: pain with shoulder abduction
- Lift off test: pain with internal rotation and push
- O’ Brian’s test: pain with rotation and abduction
What test is used to identify labral tear?
- Apprehension test: pain on pushing the humeral head
What are the treatment options to manage symptoms from shoulder injury?
- Stretch and spray, acupuncture, and heat packs are low risk and may offer some symptom relief.
- NSAIDS and muscle relaxants are not particularly effective.
- High dose opioids are not indicated.
- Image guided injections may provide temporary relief allowing exercise and patient activation.
True or False: Imaging has high utility in diagnosing shoulder pain.
False
Consider it only if rehabilitation fails or weakness and loss of function progress
What is the foundational treatment for hip pain?
Exercise therapy
What are some common causes of hip pain in the elderly?
- Osteoarthritis
- Adhesive capsulitis
- Avascular necrosis
What does the Ottawa Rules specify for knee injury imaging?
- Age > 55
- Tenderness at the head of the fibula
- Isolated tenderness of the patella
- Inability to flex knee to 90 degrees
- Inability to walk 4 weight bearing steps
What is the most common knee condition in patients over 45?
Osteoarthritis
morning stiffness and knee crepitus
Fill in the blank: Pain without physical provocation in the hip may indicate _______.
rheumatologic, infectious, or cancer
What are the three compartments of the knee?
- Tibiofemoral
- Patellofemoral
- Proximal tibiofibular
What is the recommended management for knee osteoarthritis?
- Maintain or improve function
- Encourage activity
- General exercise with Physical Therapy
- Short-term NSAIDs
True or False: Opioids are indicated for shoulder pain management.
False
What type of imaging is beneficial for early diagnosis of inflammatory hip conditions?
Hip MRI
Where is blood supply most vulnerable in the hips?
femoral neck
What is the Faber test?
Tests hip flexion, abduction, and externatl rotation
While patient is supine, ask to bend one knee and cross leg. Attempt to push down on the knee to test external rotation while stabilizing the hips with your other hand. Compare to other leg.
What is the most common reason for hip replacements in young people?
avascular necrosis of the femoral neck: loss of blood supply to the femoral neck leads to bone degradation.
