Chronic Pain 3 - Assessment and Measurement Flashcards
Stats about pain - how many dollars a year
800 billion !!!
pain affects more americans than diabetes, heart disease and CA combined
Pain =
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Stages of pain
Acute = 0 to 3 months Subacute = 3 to 6 months Chronic = persistent, more than 6 months
Can impact tx - tissue healing and perceived pain overtime
Subjective assessment
The subjective evaluation is the most important component in establishing an effective treatment plan
Pain driver - A new SPIN on SIN
S - severity P - pain driver I - irritability N - nature S - stage S - stability
McGill Pain questionnaire
Total score provides multidimensional measure of pain intensity
Items 1-11 = sensory
Items 12-15 = affective
Clinically important change is more than 5 on 0-45 scale
Pieces on McGill
Throbbing, Shooting, Stabbing, Sharp, Cramping, Gnawing, Hot/Burning, Aching, Heavy, Tender, Splitting, Tiring/exhausting, Sickening, Fearful, Punishing/cruel
Nociceptive pain - subjective
Intermittent, sharp pain with aggravation
Dull ache or throbbing at rest
Mechanical nature to aggravating/easing factors
Pain proportional to injury/pathology
Pain localized to area of injury/pathology
Resolves in accordance with expected tissue healing times
Responsive to simple analgesics
Pain in association with symptoms of inflammation
Pain of recent onset
Nociceptive pain - objective
Clear, consistent, and proportionate mechanical/anatomical pattern of pain
Reproduction on movement or mechanical testing of target tissues
Localized pain on palpation
Absence of hyperalgesia or allodynia
Pain relieving postures or movement patterns
Neuropathic pain - subjective
Burning, shooting, sharp or electric shock like pain
Hx of nerve injury or patho
Neuro symp (numb, ting, weak, pins/nee)
Less responsive to simple analgesics, more responsive to anti epileptics/anti depressants
Severe and irritable pain
Mechanical pattern associated with loading/compression of neural tissue
Reports of spontaneous pain
Neuropathic pain - Objective
Symptom provocation with tests that move/load/compress neural tissue (neurodynamic testing)
Pain with palpation of neural tissues
Pos neurological findings (altered reflexes, sensation in a dermatomal distribution)
Hyperalgesia and/or allodynia
Central sensitization - subjective
Severe, irritable, unremitting pain disproportionate to nature of initial injury
Pain persists beyond expected tissue healing times
Widespread, non anatomical pain distribution
Multiple, non specific aggravating/easing factors that are non mechanical
Neuro type symptoms
Limited relief from meds like NSAIDs and more responsive to anti dep and anti epil
Sens to sound, smell, hot, cold, light touch
Association with psych factors, maladaptive bx, disturbed sleep
Hx of failed intercention
Presence of co-morbidities associated with pain sensitiviy
Central sensitization pain - objective
Disproportionate, inconsistent, non mechanical pattern of pain provocation
Hyperalgesia and allodynia
Diffuse, non anatomic stress of pain on palpation
Positive identification of psych factors (catastrophizing, fear avoidance, distress)
Tool for central sensitization
Central sensitization inventory is a validated tool
Asks them about sleep, anxiety, clinch jaw, light sens - puts into context things for them and helps them step outside of their views and realize that it might be something mrore complex
Ankle pain case -
Allodynia putting sock on 8/10 pain with shooting High irritability with spontaneous pain N/T Sens to SLR with peroneal n bias Pain persisting No relief with OTC meds
What type of pain
Neuropathic
Neuropathic pain –> neuro anatomically logical - following peroneal nerve - but this patient is also suffering from central sensitization –> but there is a neuro anatomical alignment of the pain so neuropathic pain is the main driver
