Pain Assessment Flashcards
Pain assessment must focus on these 6 aspects of pain
-sensory
-cognitive
-emotional
-behavioral influences
-spiritual influences
-effects
An assessment of persistent pain that is solely focused on identifying the ____ will likely lead to ____ for both the patient and the provider
-pain generator
-frustration
Michna, Ross, Hynes, et al. found that the quality of the therapeutic relationship is more predictive of _____ than specific technique used
improvement
Research done by Naomi Eisenberger discovered what?
A shared neural circuitry between physical pain and social pain (rejection, loss of relationship)
The goal of the pain interview is: (three things)
-build trust
-gather information
-facilitate change
During your assessment/pain interview, these are SEVEN red flags that will alert you to something serious:
- Bowel/bladder dysfunction –>
- Saddle Anesthesia (perineal numbness) –> cauda equina syndrome
- Bilateral leg weakness –> motor lesion
- Severe, sudden onset headache –> stroke, hemorrhage
- Fever, weight loss, night sweats –> Tb, CANCER
- Recent Injury –> change in medical status. ie new clot? fx?
- Hx of cancer –> OPIOID tolerance, resistance to anesthetics, poor post-op pain management
OPQRSTU
Onset
Provocative/Palliative
Quality/Character
Region/Radiation
Severity
Timing/Treatment
U You/Impact
Define catastrophizing
Negative cascade of distressing thoughts and emotions about actual or anticipated pain
Why is catastrophizing such a poor coping response?
it is associated with higher pain intensity, likelihood of developing chronic pain, and poor treatment response
Psychiatric conditions such as _____ and _____ and _____ are associated with higher pain intensity and pain related disability
anxiety, depression, PTSD
Poor sleep is associated with ____ and _____ of chronic pain.
onset, worsening
Hx of substance use disorder including tobacco is associated with increased likelihood of _____ ________ use and abuse.
prescription opioid
If confrontation is unavoidable, suggest a break and seek ____________________.
Assistance from a team member
________ and _____ _______ may indicate the presence of inflammatory or systemic pathology
erythema, skin rash
This technique can aid in the diagnosis of myofascial pain and identify treatment targets
Palpation
Reduction in ROM can aid in the diagnosis of these specific conditions
ankylosing spondylitis, frozen shoulder
Symptom exacerbation during ROM can aid in the diagnosis of these specific conditions
cervical radiculopathy, facet arthropathy
unilateral steppage or slap-foot (foot drop) indicates what?
common peroneal nerve palsy or L5 radiculopathy
Define myotomes
muscle groups innervated by specific spinal nerves
Pathologic reflexes include:
Babinski, Hoffman, and clonus
(Hoffman reflex is the picture below)
What is a spurling’s test?
Assessing for cervical radiculopathy
What is a tinel’s test?
Noninvasive method of tapping the skin over a nerve to assess nerve irritation
What is a phalen’s test?
When should diagnostic imaging be used?
ONLY when red flag signs and a physical exam suggest a red flag condition
Of the 98 people from the ages of 20-80 yrs old that had an MRI, what percentage of them had normal discs at all levels?
only 36%
Should acute lower back pain be imaged within the first six weeks?
NO, unless any red flags are present or progressive neurologic deficit, osteomyelitis is suspected
You should NOT image uncomplicated headaches unless:
-abnormal neurologic exam
-unable to diagnose by hx and exam
- HA is sudden or explosive
-different from prior HA’s, especially in people >50 yrs old
-progressively worsening
-brought on by exertion
-accompanied by fever, seizure, vomiting, a loss of coordination, speech/vision/alertness changes
- the patient is immunocompromised or with a known malignancy
Is pain intensity measured by these tools adequate enough for patients with chronic pain? Which tool is better?
No. PEG (Pain, Enjoyment, and General activity) is better
PEG
Pain, Enjoyment, General activity
What is a STOP-BANG assessment?
Sleep apnea assessment tool.
A score of > or = 3 has shown a high sensitivity for detecting OSA: 93%
5-8 identified patients with high probability of moderate/severe OSA
What is the ORT?
Opioid Risk Tool –> risk of opioid abuse
0-3 Low Risk
4-7 moderate risk
> or = 8 high risk
We use the four A’s to assess the effectiveness of our pain management treatments. What are they?
Activity –> increased?
Analgesia –> pain relief?
Aberrant drug related behavior –> taking other drugs?
Adverse effects –> constipation, drowsiness, low libido?
(+2) after the four A’s
Affect –> sad, worried, frustrated?
Adjunct –> you exercising? relaxing? yoga?
Neck pain can cause _____ pain or _______.
Arm pain, headaches (cervicogenic headaches)
Which nerves can be involved in neck pain?
occipital nerve, dermatomes
Which muscles are potentially involved in neck pain?
Rhomboids
Upper traps
scalene
levator scapulae
sternocleidomastoid
Most neck pain will be what kind of pain?
Myofascial pain
What is myofascial pain?
a chronic condition that causes pain in muscles and connective tissues characterized by trigger points in muscles that can radiate pain to other parts of the body
The rectus femoris is the one quadricep which both crosses the ___ and crosses the ____, thus acts to both extend the knee and flex the hip.
knee, hip
The hamstrings cross the hip as the proximal attachment is on the ________ __________ and distally cross the knees. They act to extend the hip and flex the knee.
Ischial tuberosity
A reliable exam to assess for meniscal injury to the knee
Thessaly test
sometimes patients come in with ‘_____ _______syndrome’, which is a ligament passing tightly over a bony prominence,
Snapping hip
The snapping sensation can be so strong that the patient complains that they have “__________” their hip, but that doesn’t happen without trauma because of the strong bony and ligamentous structure.
dislocated
The circulatory map (of the hip) shows why it’s important to perform imaging when the history and exam suggests ______ ________. Which arteries are involved?
Avascular necrosis
Retinacular arteries
Cervical facet pain can present as _______ pain.
Shoulder
What is a drop arm test? What does it assess?
Abduction of the shoulder. Assesses for pain with shoulder abduction, potentially indicating rotator cuff tear
What is a lift off test? What does it assess?
Assessess internal rotation of the shoulder. Pain is a positive test, assessing for rotator cuff tear
What is O’Brien test? What does it assess?
Internal rotation combined with abduction of the shoulder. Pain is a positive test, assessing for rotator cuff tear
Which cervical vertebra separates upper from lower neck pain?
C4
What is the prognosis for acute neck pain recovery in the absence of any red flags?
Very favorable
If osteoarthrosis is the presumed cause of pain, can it be detected by imaging?
No
Most chronic neck pains in the absence of trauma and red flags are unknown. Even if patients demand an investigation, will imaging reveal a cause?
Most likely no
Which block is useful in diagnosing zygapophyseal (facet) joint pain?
Median branch block
Referring neck pain usually has a ____ neurologic exam. Radiating neck pain has an _______ neurologic exam.
normal. abnormal
Between which two areas of the spine is the region that designates the “lower back” in terms of back pain?
T12 spinous process - coccygeal spine
Cauda Equina syndrome is caused by what?
damage to the lumbar-sacral nerve roots. Could quickly progress to paralysis
Differentiate injury to the cauda equina (below L2) and injury to the conus medullaris (L1-L2).
What is the preferred test for a fracture?
x-ray
What is the preferred test for a stress fracture?
Bone scan or MRI
x-ray
What is the preferred test for an aortic aneurysm?
Ultrasound
What is the preferred test for a pathologic fracture?
1st line: ESR, CBC, CRP
2nd line: MRI
What bone disease should be suspected in all patients over 50?
Osteopenia
Which disease processes can cause referred pain to the shoulder?
MI, cervicogenic headache, and cholecystitis
What is an apprehension test and what do we use it for?
Pushing on the humeral head. Assessing for potential labral tear
Hip joint anatomy
