Pain Lecture Flashcards
What are the four sources of pain?
Cutaneous (somatic)
Deep somatic
Visceral
Referred
What are the characteristics of cutaneous pain?
Refers to pain along the skin
Localized with one finger
Associated with referred or deep somatic pain but again, localized
What are the characteristics of deep somatic pain
Bone, nerve, muscle, tendon, ligament, arteries, joints, spongy or cancellous bone, periosteum
Poorly localized
Often referred
What are the characteristics of visceral pain?
Internal organs, heart
muscle
Poorly localized because of multi-segmental innervation (cardiac pain: C3-T4)
Pain corresponds to dermatomes from which organ receives its innervations
Few nerve endings
Visceral pleura insensitive to pain
Associated with ANS response
What are the characteristics of referred pain?
From cutaneous, soma, viscera
Pain felt in area far from site of lesion but supplied by same or adjacent neural segments
Includes all structures: cutaneous, deep somatic, and visceral
Most of the time, it refers distally
Usually well-localized
Can spread or radiate from point of origin
Can occur alone but usually preceded by visceral pain when organ is involved
What are the mechanisms of referred visceral pain?
Embryologic development
Multisegmental innervation
Direct pressure and shared pathways
What are the possible visceral pathologies with pain in the RIGHT SHOULDER?
Liver
Perforated duodenal ulcer
What are the possible visceral pathologies with pain in the RIGHT POSTERIOR AXILLA?
Penetrating duodenal ulcer
What are the possible visceral pathologies with pain in the MIDDLE POSTERIOR BACK?
Penetrating duodenal ulcer
What are the possible visceral pathologies with pain in the RIGHT POSTERIOR FLANK?
Cholecystitis
What are the possible visceral pathologies with pain in the LOW BACK?
Pancreatitis
Renal colic
What are the possible visceral pathologies with pain in the SACRUM?
Rectal lesions
What are the possible visceral pathologies with pain in the LEFT POSTERIOR SHOULDER?
Pancreatitis
What are the possible visceral pathologies with pain OVER LEFT BREAST, MEDIAL ARM?
Heart
GERD
What are the possible visceral pathologies with pain UNDER RIGHT BREAST?
Biliary colic
What are the possible visceral pathologies with pain in the RIGHT UPPER ABDOMEN?
Cholecystitis
Pancreatitis
Duodenal ulcer
What are the possible visceral pathologies with pain UNDER LEFT BREAST?
Peptic ulcer
Renal ulcer
What are the possible visceral pathologies with pain in the RIGHT LOWER ABDOMEN (Erb’s point)?
Appendicitis
What are the possible visceral pathologies with pain OVER THE NAVAL?
Small intestine
Appendicitis
What are the possible visceral pathologies with pain OVER THE PUBIC REGION?
Colon
What are the possible visceral pathologies with pain in the LEFT GROIN?
Ureteral colic
What are the possible visceral pathologies with pain in the SHOULDER AND LOW BACK?
Diaphragm
What are the possible visceral pathologies with pain in the SHOULDER, NECK, UPPER BACK, and GENITALIA?
Urogenital tract
What are the possible visceral pathologies with pain in the SHOULDER, MIDTHORACIC/LOW BACK?
Pancreas
Liver
Spleen
Gall bladder
If you have a lesion at C7 or between T1 and T5, what somatic representation of that pain should be expected?
Pain in inter-scapular area
Pain in posterior shoulder
If you have a lesion at the shoulder, what somatic representation of that pain should be expected?
Pain in neck
Pain in upper back
If you have a lesion at L1 or L2, what somatic representation of that pain should be expected?
Pain in the SI joint
Pain in hip
If you have a lesion in the hip joint, what somatic representation of that pain should be expected?
Pain in SI joint
Pain in knee
If you have a lesion around the pharynx, what somatic representation of that pain should be expected?
Pain in the ipsilateral ear
If you have a lesion at the TMJ, what somatic representation of that pain should be expected?
Pain in the head
Pain in the neck
Pain in the heart
What are the characteristics of pain that your patient will disclose to you?
Location/onset
Description
Intensity
Duration
Frequency
As far as PATTERN with pain goes, what are the things you are assessing?
Vascular–sensation of a pulse
Neurogenic–numbness and tingling
MSK (Spondylogenic)–aching, throbbing
Neuromuscular–shooting pain, sharp pain
Emotional–widespread pain, dural pain can present multi-segmentally and bilaterally
Visceral pain–gradual, progressive, or cyclical; constant, intense, unrelieved by rest or change in position; does not fit expected mechanical or NM pattern
As far as the AGGRAVATING/RELIEVING FACTORS with pain go, what are the things you are assessing?
Cannot alter, provoke, alleviate, eliminate, aggravate symptoms
PT intervention does not change the clinical picture (or client gets worse)
Pain description (colicky, knife-like, boring, deep aching)
What are the various positions to relieve pain when speaking of pain from ORGANS?
RELIEVING:
Gallbladder–lean forward
Kidney–lead to affected side
Pancreas–sit upright/lean forward
AGGREVATING:
Esophagus–swallowing
GI–peristalsis (eating)
Heart–cold/exertion/stress
What are some things to consider with NIGHT PAIN?
Pain that awakens patient from a sound sleep
Pain that is not relieved by change in position
Pain that is accompanied by dyspnea, diaphoresis, or other symptoms
Pain that is relieved by eating food or taking tums
Shoulder pain that goes away when lying on the painful side
Shoulder pain that is worse when lying supine and gets better by sitting up
Night pain that is worse with weight-bearing
What are the 5 types of MYOFASCIAL PAIN?
Trauma
Muscle spasm
Muscle tension
Muscle deficiency
Trigger points (TrPs)
What are some things to know about trigger points?
Pain is produced or increased with palpation (latent vs active)
Presence of a taut band of tissue
Reproduced by resisted motions
History of…
- Prolonged or vigorous activity (bending, lifting)
- Forceful abdominal breathing (marathon runners)
In cases of pain, watch out for:
- Symptoms out of proportion to injury
- Symptoms persisting beyond expected time for physiologic healing
- No position of comfort
What are three things that you want to look at when screening for EMOTIONAL OVERLAY?
McGill Pain Questionnaire
Symptom magnification
Waddell’s nonorganic signs
What is the McGill Pain Questionnaire?
Considered a good baseline for assessing pain
Has a high reliability and validity in younger populations–has not been tested in the old
What is SYMPTOM MAGNIFICATION?
A self-destructive, socially reenforced behavioral response pattern consisting of reports or displays of symptoms which control the life of the sufferer
Symptoms rather than physiologic phenomenon of the injury determine the outcome/function
What do you do with a NONORGANIC TEST SEQUENCE?
Tenderness–nonanatomic over large area, unable to localize or pinpoint
Simulation tests such as axial loading and rotation
Distraction
- Observation, hand client shirt/coat
- SLR ~ flip test
Regional disturbances
- Entire leg is numb or painful
- Pain is not localized in a single dermatomal or myotomal pattern
- Leg gives-way/ large muscle group
Over-reaction
- Client applies minimal effort on maximum performance task
- Client over-reacts to loading during objective examination
