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
