FMC (Unit 4 Patient Presentation) Flashcards
What is SINSS?
-Characteristics of the patients presenting symptoms
S- Severity
I- Irritability
N- Nature
S- Stage of condition
S- Stability
What is the purpose of SINSS?
-Its a guide in clinical decision-making
-Reduces clinical reasoning errors
What can Severity tell you about the patient?
It can tell us how the patient’s symptoms affect their actives of daily living (ADLs)
We would also put this in the ICF model in:
-Activity limitations
-Participation Restrictions
In the Severity portion in SINSS, how can we determine the intensity of the patient’s pain?
-Using the Numeric Pain Rating Scale (NPRS): 0-10
Rating:
-Low
-Mod.
-High
In the Severity Portion in SINSS, what must the therapist consider when determining the intensity of the patient’s pain?
-Medications used to control pain
-Presence or absence of night pain
-Impact of symptoms on sleep
Pain and activity don’t always correlate
In the Severity portion of SINSS, how can we determine the impact of pain on function?
Using the Patient-Specific Functional Scale (PSFS):
-A self-reported outcome measure on function (0-10)
In the Severity portion of SINSS, what would be considered low severity?
0-3 / 10 in the Numeric Pain Rating Scale, 8-10 / 10 in the Patient-Specific Functional Scale
-No limitations to ADLs, work, or recreational activities
-Verbal & nonverbal cues indicate minimal to no pain
-Not taking Pain meds.
-No impact on sleep
In the Severity potions of SINSS, what would be considered Moderate Severity?
4-7 / 10 in the Numeric Pain Rating Scale, 4-7 / 10 in the Patient-Specific Functional Scale
-Moderate limitations to ADLs, work or recreational activities and avoidance of more demanding requirements
-Verbal & nonverbal cues indicate the presence of moderate pain
-Intermittent mild pain-relieving medications may be required to function and sleep
-Sleep disturbance possible
In the Severity portion of SINSS, What would be considered High severity?
8-10 / 10 in the Numeric Pain Rating Scale, 0-3 / 10 in the Patient-Specific Functional Scale
-Maximal limitation to regular ADLs and may be avoiding work or recreational activities
-Verbal & nonverbal cues indicate the presence of intense pain
-Frequent pain-relieving medications may be required to function and sleep
-Sleep disturbance likely
What can Irritability tell you about the patient? What should the therapist consider?
The behavior of the symptoms
Should consider:
-Amount and type of activity to aggravate symptoms
-Amount and type of activity to ease symptoms
-Ration of the magnitude of aggravating factors to easing factors
In the Irritability portion of SINSS, what are the criteria’s to assess?
Aggravating Factos (“Aggs”)
-Intensity of the activity to agg
-Time to onset or exacerbation
-Intensity at onset - NPRS
-Intensity at worst - NPRS
Easing Factors (“Eases”)
-Activity or Reduction of activity to ease
-Time to ease
-Intensity at best - NPRS
In the Irritability portion of SINSS, what are the three symptom characteristics?
Constant vs. Intermittent
Consistent vs. Variable
Constant vs. Consistent
(Red Flag)
In the Irritability portion of SINSS, what would be considered a low rating irritability?
High intensity activity to agg
-Ex. Running
Minor reduction in activity to ease
-Ex. Walking
Greater time to agg and less time to ease
-Ex. It takes 60 min to be 6/10 NPRS // Takes 10 min to 0/10 NPRS
In the Irritability portion of SINSS, what would be considered a Moderate rating irritability?
Moderate intensity activity to agg
-Ex. Walking
Moderate reduction in activity to ease
-Ex. Sitting
Similar time to agg to ease
-Ex. It takes 60 min to be 6/10 NPRS // Takes 60 min to 0/10 NPRS
In the Irritability portion of SINSS, what would be considered a High rating irritability?
Low intensity activity to agg
-Ex. Standing
Significant reduction in activity to ease
-Ex. lying down
Less time to agg and greater time to ease
-Ex. Takes 5 min to be 6/10 // Takes 60 min to be 0/10
What is Nature and what does it include?
It is a broad, conceptual term
Includes:
-The specific diagnosis or condition
-The nature of the patients themselves
-The nature of the pain itself
(Nociciceptive, Nociplastic, Neuropathic)
-Each clinical presentation is unique
-All factors that should be considered as you are planning the physical exam
In the Nature portion of SINSS, what are components to consider?
-Mechanism of Pain
-Involved Systems
-Involved Structures
-Diagnostic Classifications
-Psychological and social factors
What is Stage of Conditions in SINSS?
A composite assessment of the patient’s present symptoms involving severity and irritability with respect to known tissue damage
What are the three agreements in the Stage of Condition portion of SINSS?
-Pain does not directly correlate to tissue damage
-Tissue damage can influence pain
-Stage of condition ≠ Phase of tissue healing
In the Stage of Conditions portions of SINSS, what would be considered Acute?
Acute: High Irritability and highly sever
-Limited physical examination
-Treatment approach: Symptoms modulation
In the Stage of Conditions portions of SINNS, what would be considered Subacute?
Subacute: Moderate irritability and Moderatly sever
-Physical examination seeking impairment
-Treatment control: Movement control
In the Stage of Conditions portions of SINSS, what would be considered Chronic (Stable)?
Chronic (Stable): Low Irritability and low severity
-Less limited, more vigorous physical examination
-Treatment approach: Function optimization
In the Stage of Conditions portions of SINNS, what would be considered Chronic (Unstable)?
Chronic (Unstable): High severity, unpredictability
-Limited, Specialized physical examination
-Treatment approach: Patient education and functional optimization
In the Stage of Conditions portion of SINSS, what are the signs and symptoms of Coagulation and Inflammation phase?
-Redness, swelling, heat, pain
-Pain at rest
-pain with active movement when:
–specific stress to the injured structure
Takes ~72 hours to heal
In the Stage of Conditions portion of SINSS, what are the signs and symptoms of Migration and Proliferative Phase?
-Signs of inflammation decreased
-swelling usually still present
-Redevelopment of wound tensile strength
-Capillary growth and granulation tissue formation
-Fibroblast proliferation with collagen synthesis
-Increased macrophages and mast cell activity
Takes ~several weeks to heal
In the Stage of Condition portion of SINSS, what are the signs and symptoms of Remodeling Phase?
-No signs of inflammation or swelling
-No scar formation
-New tissue development
~3 months - 1 year depending on tissue
At 12-15 weeks, primary healing completed
In the Stage of Condition portion of SINSS, what is Acute-On-Chronic?
Recurrent-repeated episodes of evaluated irritability of the same condition
–Tissue damage may or may not be present
-Both have nociceptive mechanism of pain
–Not nociplastic
What is Stability in SINSS?
Progression of the patients symptoms over time
-Current episode
-All episodes
“Is the condition improving, worsening, or staying the same over time, or am I unable to determine the behavior of the symptoms”
In the Stability portion of SINSS, what would be improving symptoms?
-Decreased intensity, frequency, and/or location
-Sleep patterns uninterrupted or restored
-Less medication use
-Return to regular movement or function
In the Stability portion of SINSS, what would be worsening symptoms?
-Increased intensity, frequency, and/or location
-Sleep patterns disrupted
-More medication use
-Regression of movement of function
In the Stability portion of SINSS, what would be Unchanging symptoms?
-No change overall in time
-No change in sleep patterns
-No change in medication use
-Stagnant progress toward normal functioning
In the Stability portion of SINSS, what would be Waxing and Waning?
-Sometimes improving, sometimes worsens
-May be dependent on external factors
What may you find in the subjective exam for Nociceptive Pain?
-Clear, proportionate mechanical/anatomical nature to aggravating and easing factors
-Pain associated with and proportion to trauma or a pathological process or movement/postural dysfunction
-Pain localized to the area of injury/dysfunction
-Usually rapidly resolving or resolving in accordance with expected tissue healing/pathology recovery times
-Pain associated with inflammation (Swelling, redness, heat)
-No neurological symptoms
What may you find in the objective exam for Nociceptive Pain?
-Clear, consistent pattern of pain reproduction on movement testing on target tissues
-Localized pain on palpation
-Antalgic (Pain relieving) postures and movement patterns
-Absence of neurological signs
What is the definition of Neuropathic Pain?
Pain caused by a lesion or disease of the somatosensory nervous system
What may you find in the Subjective exam for Neuropathic pain?
-Pain described as burning, shooting, sharp, aching, or electric like
-History of nerve injury, pathology or mechanical compromise
-Pain in association with other neurological symptoms (Pins and needles, numbness, weakness)
-Pain of high severity and irritability (Easily provoked, takes longer to settle)
-Pain worse at night with sleep disturbances
-Pain associated with psychological affect (mood disturbances, distress)
What may you find in the Objective exam for Neuropathic pain?
-Pain/symptom provocation with movement/mechanical test that move/load/compress neural tissue
-Pain/symptom provocation of relevant neural tissue
-Positive neurologic findings
-Latent pain in response to movement/mechanical testing
-Signs of autonomic dysfunction
What is Nociplastic Pain?
Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain
What may you find in the Subjective exam for Nociplastic Pain?
-Unresponsive to NSAIDs and/or more responsive to anti-epileptic or anti-depressant medication
-Reports of spontaneous pain and/or paroxysmal pain (sudden recurrences and intensification of pain)
- More constant/unremitting pain
-Night pain/disturbed sleep
-Pain of high severity and irritability (easily provoked, takes long to settle
-Pain persisting beyond expected tissue healing/pathology recovery times
-History of failed interventions
What may you find in the Objective exam for Nociplastic Pain?
-Disproportionate, inconsistent, non-mechanical/non-anatomical pattern of pain
-Diffuse/non-anatomic areas of pain/tenderness on palpation
-Positive identification of various psychosocial factors (fear-avoidance, behavior, distress, catastrophization)
In the Biopsychosocial Model, what are the four elements? What is in each element?
Tissue: Inflammation, Proliferation, Remodeling
Input: Nociceptive pain, Peripheral neurogenic pain
Output+Homeostatic mechanisms: Endorphin, Autonomic, Immune, Motor, Pain control
Processing: CNS sensory, Psychosocial, Processing
What is Triangulation?
Asking questions with outcome tools to point us into direction of pain without using bias
What are typical pain descriptors with Neurological origin?
Stabbing, burning, tingling, shooting, piercing, electric like
What are typical pain descriptors with muscle origin?
Aching can be sharp–acute or dull-chronic
What are typical pain descriptors of Mechanical/vascular pain?
Edema or effusion: throbbing
What are typical pain descriptors with joint origin?
Usually deep ache
