Clinical Assessment of Pain Flashcards
we cannot know someone else’s pain experience beyond what two things
why can using a patient’s narrative over a pain scale be problematic
why is rating pain on a scale of 0-10 hard
their ability to describe it and our ability to interpret their description
some people have alternative motives for rating pain high, they may not have a means to express their pain
its subjective and depends on what anchors you use/what you say a 10/10 would be
what does the multimodal assessment model of pain (MAMP) prioritize
the MAMP acknowledges that the patient’s ability to describe their pain is limited by what 4 things
the patient’s narrative as the closest we as outside observes can get to the true pain experience
their ability to make sense of the experience, their access to and use of language, their prior experiences, metaphors/analogy that are available to them
out ability to interpret the patient narrative is limited by what 3 factors
our personal and professional lenses and values, our ability to interpret and understand their choice of words/metaphors, our own past experiences and need to make meaning
what are the benefits of using clinical pain assessment tools
when applied poorly, what effect can pain assessment tools have
bridges a gap between patient experience and clinician understanding, can be useful for shared decision making between client and provider
can reduce the rich experience of pain to a single number that becomes the focus of treatment
why should we evaluate pain
creates a shared language around the experience of pain
can help orient patient and provider to the baseline of the pain experience (where are we starting)
can create patient partnered milestones or indicators for improvement
can identify higher priority treatment targets
used for screening, prognostic, theranostic and discharge decisions
describe the numeric pain rating scale (NPRS) (anchors, how it’s administered, objective or subjective measure, what is considered a clinically meaningful change)
0-10 scale with 0 being no pain and 10 being worst pain ever, worst pain imaginable, extreme pain
administered verbally or on paper/computer
is a subjective measure of pain
2 point change is clinically meaningful
explain what the visual analog scale (VAS), Wong baker faces scale, and verbal descriptor scales are
VAS: patient puts a mark on a line from no pain to extreme pain and their line is measured from the end of the line
face scale: a 0-5 scale that uses faces and a description to depict what each rating means
verbal descriptor: like the NPRS but replaces numbers with words
what is a limitation to the Wong baker faces scale and what demographic would we administer this scale to
could be measuring emotions instead of pain
administered to children or cognitively impaired adults
what does the radar plot help us understand and what are it’s 7 domains
helps us understand the components that go into patient’s pain ratings on scales by tapping into 7 different domains
socioenvironmental, sensorimotor disintegration, nociceptive/physiological, peripheral neuropathic, central nociplastic, emotional/affective, cognitive/belief
how can you use the radar plot to guide treatment
begin with the component that is highest for the patient because that is what affects their pain experience the most
what domain affects their pain experience may change over time
what is triangulation and how does it relate to the radar plot
the idea that if 3 sources of information all converge on the same point you can be certain that the answer is right there
if you have 3 sources of information that tell you pain experience is driven by emotional factors you can conclude that it is a strong driver
which domain of pain is similiar to neuropathic but differs in that it doesn’t follow a peripheral nerve distribution
central/nociplastic pain
what is exercise induced hyperalgesia, what test may indicate this could happen
when a patient with central nociplastic pain becomes more sensitive to pain after exercise (reverse response to pain modulation)
the ice bucket test, if submerging the hand in ice then re testing the injured area causes increased sensitivity to pain (in normal subjects the pain threshold should increase, not decrease)
describe the characteristics of sensorimotor disintegration pain (symptoms, what it does/does not respond to, give an example)
clumsiness due to poor proprioception (joint sense position), poor two joint discrimination, difficulty identifying boundaries of the injured body part in space, reports that the body is smaller or larger than actual or even foreign
unlikely to respond to NSAID or analgesics
may respond to manual/mechanical or movement based interventions
acute whiplash (muscles that are tight on one side tell you you are leaning to that side but the eyes and vestibular system tell you that you’re straight up and down)
describe the characteristics of cognitive pain
what kind of questionnaires can you administer to these individuals and what does it measure
strong negative orientation towards pain, catastophizing, fearful of certain movements, feels fragile/vulnerable, low expectations for improvement, doesn’t understand the pain, sense of hopelessness/helplessness
don’t have strong evidence from mechanical tests and patient will report “nothing can help” or “im never going to be the person I was before”
fear avoidance beliefs questionnaires, measures avoidance of activity out of fear more than out of pain
what are indicators of emotional pain
pain associated with emotion or mood (depression, anxiety), psychopathology screening tools are positive, not clearly associated with movement/palpation or other clinical tests, poorly localized pain, may or may not have been preceded by an inciting MSK trauma
what is socioenvironmental pain, give examples
anything external to the patient that may affect the experience or reporting of pain
relationships with others and their response to our pain, housing/food/job/relationship security, prior experiences of abuse/oppression/marginalization
