Pain Assessment Flashcards
What is the primary goal of a comprehensive pain interview?
To build trust, gather information, facilitate change, and understand the patient’s perspective.
What does the OPQRSTU mnemonic stand for in pain assessment?
- O: Onset
- P: Provocative/Palliative
- Q: Quality/Character
- R: Region/Radiation
- S: Severity
- T: Timing/Treatment
- U: You/Impact
What are some common red flags to rule out during a pain assessment?
- Bowel/bladder dysfunction
- Saddle anesthesia
- Bilateral leg weakness
- Severe, sudden onset headache
- Fever, weight loss, night sweats
- Recent injury
- History of cancer
What are medical comorbidities that should be identified during a pain assessment?
- Lung and sleep disorders
- Obesity
- Heart disease
- Liver disease
- Kidney disease
True or False: A diagnosis of ‘chronic pain’ is sufficient without a specific pain patho-anatomic diagnosis.
False
What is the significance of countertransference during patient interviews?
It can elicit emotional responses that provide insight into the patient’s situation and motivations.
What are the components of a clinical exam for pain assessment?
- Inspection and General Appearance
- Mental Status
- Vital Signs
- Posture and Gait
- Palpation
- Range of Motion (active and passive)
- Neurological Examination
- Special Tests
What should be done if red flag signs and a normal physical exam are present?
Routine imaging should be avoided as it may reinforce sick behavior and worsen long-term outcomes.
What does the STOP-BANG screening tool assess?
The presence and need to treat obstructive sleep apnea.
What is the definition of acute neck pain?
Pain that is present for less than 3 months.
Fill in the blank: Neck pain can refer to the _______ or _______.
[head], [arm]
What is the prognosis of acute low back pain without trauma or red flags?
Favorable, with 80% expecting to recover rapidly.
What are some key features of Cauda Equina Syndrome?
- Severe symptoms
- Asymmetric symptoms
- Saddle anesthesia
- Weakness to flaccid paralysis
What are the two types of neck pain based on duration?
- Acute Neck Pain
- Chronic Neck Pain
What is the importance of a physical exam in pain assessment?
To exclude red flags, complement psychosocial assessment, and quantify impairment.
What should be the first line investigation for suspected fracture?
X-ray
What is the role of imaging in acute low back pain?
Do not image within the first six weeks unless red flags are present.
What is the significance of the Widespread Pain Index (WPI) in fibromyalgia assessment?
It helps diagnose and assess the severity of fibromyalgia.
True or False: Opioids are indicated for the treatment of neck pain.
False
What is a key characteristic of radiating neck pain?
It follows dermatomes and usually has an abnormal neurological exam.
What are some factors that can increase the risk for chronic low back pain?
- Stress at work
- Previous injuries
- Litigation
What are the four A’s used to assess treatment effectiveness?
- Activity
- Analgesia
- Aberrant drug-related behavior
- Adverse effects
What are the symptoms of chronic neck pain?
Pain present for more than 3 months, often with an unknown cause in the absence of trauma.
What should be done if neck pain persists despite conservative treatment?
Perform an MRI to detect an occult lesion and order image-guided diagnostic tests.
What is the first-line imaging method for diagnosing a stress fracture?
X-ray
MRI and bone scans may be used for further evaluation.
Name two risk factors for infection related to musculoskeletal issues.
- Invasive medical procedure
- Immunosuppression
Other factors include injection, illicit drug use, trauma to skin or mucous membrane, and diabetes mellitus.
What are the common symptoms indicating the need for imaging when shoulder pain is present?
- Fever
- Weight loss
- Pain not relieved by rest
These symptoms may indicate underlying serious conditions.
What is the primary component of the shoulder and pectoral girdle?
Scapula, clavicle, and humerus
These bones work together to form the shoulder joint.
List three tests used during a shoulder examination.
- Apley scratch test
- Neers test
- Drop arm test
These tests help assess shoulder pain and functionality.
True or False: MRI is indicated for all cases of shoulder pain.
False
MRI is typically used only if rehabilitation fails or if there is weakness and loss of function.
What is the most common cause of hip pain in the elderly?
Hip Osteoarthritis
Other conditions may also present but osteoarthritis is the most prevalent.
Fill in the blank: The hip joint is a ______ joint consisting of the femoral head and the acetabulum.
ball-and-socket
What is the foundational treatment for hip pain?
Exercise therapy
Active physical therapy is preferred over passive treatments.
What are the three compartments of the knee?
- Tibiofemoral
- Patellofemoral
- Proximal tibiofibular
What type of knee pain often occurs in patients under 45 years of age?
Patellofemoral pain
This pain is more prevalent in women and often doesn’t require surgical referral.
List two common conditions associated with knee pain in older adults.
- Osteoarthritis
- Meniscal tear
Osteoarthritis presents with morning stiffness and crepitus.
What is the purpose of the Ottawa Rules in knee injury assessment?
To determine the need for imaging
These rules help identify patients who should receive radiographic evaluation.
True or False: High-dose opioids are indicated for treating shoulder pain.
False
High-dose opioids are not recommended for shoulder pain management.
What is the role of imaging in diagnosing shoulder pain?
Limited utility unless rehabilitation fails
MRI may reveal structural issues that are not the source of pain.
What is a common treatment method for knee pain associated with bursitis?
Image guided intra-articular steroid injection
This can provide temporary relief.
Fill in the blank: Avascular Necrosis of the hip is frequently associated with _______.
corticosteroids
What condition may cause knee locking during movement?
Meniscal tear
This injury is commonly associated with twisting motions.
What are the potential causes of referred hip pain?
- Low back
- Thigh
- Buttocks
- Groin
What is the recommended management for shoulder pain in the elderly?
Discuss surgery or palliation if functionality is limited
Rehabilitation may be less effective in older patients.
