Chapter 3 Highlights

Question 1

the 5th vital sign, along with BP, temp, pulse, and respiration

Answer 1

PAIN

Question 2

⋅ 3 phenomena to consider from Western medicine approach:

Answer 2

embryologic development, multisegmental innervation, direct pressure and shared pathways

Question 3

ipsilateral ____ and ____ same shape b/c they come from same embryologic tissue and formed at same time

Answer 3

kidney and ear

Question 4

Evidence supports referred visceral pain to somatic tissues based on overlapping or same projections of spinal afferent neurons to the spinal dorsal horn= visceral-organ cross-sensitization. Cardiac pain is related to what spinal cord segments??????

Answer 4

C3-T4

Question 5

Anything that impinges the central diaphragm can refer pain to the ____ and anything that impinges the peripheral diaphragm can refer pain to the _________________

Answer 5

shoulder

ipsilateral costal margins and/or lumbar spine

Question 6

Verbal Descriptor Scale (VDS)= most sensitive and reliable among _____, including those with mild/mod cognitive impairments

Answer 6

older adults

Question 7

Child Facial Coding System (CFCS)- can be used in infants and young children

Answer 7

o Facial actions and movements (brow bulge, eye squeeze, mouth position, and chin quiver) scored as pain responses
o Can be used as behavioral measure of pain
o Valid/reliable for children 0-18 months postoperatively

Question 8

Visceral pain is not well localized for 2 reasons:

Answer 8

1. innervaton of the viscera is multisegmental

2. there are few nerve receptors in these structures

Question 9

Trigger points: hyperirritable spots within a taut band of skeletal muscle or in the fascia.
I remember there was a quiz question about trigger points, but couldn’t remember what it was, so here is all of the trigger point info……

Answer 9

o Jump sign: person physically withdraws from the pressure on the point
o Active TrPs refer pain locally or to another location and can cause pain at rest. They fagiue faster and recover more slowly.
o Latent TrPs: do not cause spontaneous pain but generate referred pain when the affected muscles are put under pressure, palpated, or strained.
o Key TrPs: have a pain-referral pattern along nerve pathways
o Satellite TrPs: set off by key trigger points
o Screen for TrPs to elimate or rule out systemic pathology as a cause of muscle pain.
o If your patient fails to respond to TrP therapy consider it a yellow flag
o Remember that visceral disease cause tender points

Question 10

Infectious arthritis –

Answer 10

local response to an infection

EX= Lyme disease, STDs, Hep B, rubella, HIV, SLE

Question 11

Organ and associated position of relief
• Gallbladder –
• Kidney –
• Pancreas –

Answer 11

– slight trunk flexion
– flexion and side bending towards involved kidney
–sitting up and leaning forward OR knees to chest

Question 12

Pain from ischemic muscle builds up with use of muscle and is relieved by rest

Answer 12

Pain lag time (5 to 10 minutes) between beginning activity and onset of symptoms →vascular / claudication

Question 13

Eating or organ function affecting pain =

Answer 13

red flag for visceral pain

Question 14

Disproportionate relief of bone pain with aspirin is red flag for

Answer 14

osteoid osteoma

Question 15

Systemic origin: early screen=full, pain free ROM. Late screen=

Answer 15

Splinting/guarding

Question 16

Anxiety more common with ____ pain. Depression more with _____ pain

Answer 16

acute

chronic

Question 17

If you notice symptoms out of proportion to injury could be two things:

1. Cancer/other systemic causes
2. Psychological overlay (symptom magnification syndrome)
   a. Use a screen – Waddells
   i. Score of 3 equals _______
   ii. Score of less than 2 is prognostic indicator

Answer 17

non-movement disorder

of return to work

Question 18

Symptom Magnification Syndrome (SMS)

Answer 18

Symptoms reinforce behavior rather than physiologic phenomenon of injury determining outcome