Pain Types and Viscerogenic Pain Patterns Flashcards
1
Q
What are the characteristics of VASCULAR pain?
A
Throbbing
Pounding
Pulsing
Beating
2
Q
What are the characteristics of NEUROGENIC pain?
A
Sharp Crushing Pinching Burning Hot Searing Itchy Stinging Pulling Jumping Shooting Electrical Gnawing Pricking
3
Q
What are the characteristics of MUSCULOSKELETAL pain?
A
Aching Sore Heavy Hurting Deep Cramping Dull
4
Q
What are the characteristics of EMOTIONAL pain?
A
Tiring Miserable Vicious Agonizing Nauseating Frightful Piercing Dreadful Punishing Exhausting Killing Unbearable Annoying Cruel Sickening Torturing
5
Q
What are the contents of the Verbal Descriptor Scale (VDS)?
A
0 = No pain 1 = Slight pain 2 = Mild pain 3 = Moderate pain 4 = Severe pain 5 = Extreme pain 6 = Pain as bad as it can be
6
Q
What are symptoms of pain characterized as in patients with cognitive impairments?
A
Verbal comments such as “ouch” or “stop”
Nonverbal vocalizations (moans, sighs, gasps)
Facial grimacing or frowning
Audible breathing independent of vaocalization (labored, short or long periods of hyperventilation)
Agitation or increased confusion
Unable to be consoled or distracted
Bracing or holding onto furniture
Decreased mobility
Lying very still, refusing to move
Clutching painful area
Resisting care provided by others, striking out, pushing others away
Sleep disturbance
Weight loss
Depression
7
Q
What is the Nursing Assessment of Pain (PQRST)?
A
PROVOCATION and PALLIATION. What causes the pain and what makes it better or worse?
QUALITY of pain. What type of pain is present (aching, burning, sharp)?
REGION and RADIATION. Where is the pain located ? Does it radiate to other parts of the body?
SEVERITY on a scale of 1-10. Does the pain interfere with daily activities, mood, function?
TIMING. Did pain come on suddenly or gradually? Intermittent? How often? How long? Does it come at the same time?
8
Q
What are the characteristics of SYSTEMIC pain pertaining to ONSET?
A
Recent, sudden
Does not present as observed for years without progression of symptoms
9
Q
What are the characteristics of SYSTEMIC pain pertaining to DESCRIPTION?
A
Knife-like (stabbing from the inside out), boring, deep ache
Cutting, gnawing
Throbbing
Bone pain
Unilateral or bilateral
10
Q
What are the characteristics of SYSTEMIC pain pertaining to INTENSITY?
A
Related to the degree of noxious stimuli; usually unrelated to presence of anxiety
Mild to severe
Dull to severe
11
Q
What are the characteristics of SYSTEMIC pain pertaining to DURATION?
A
Constant, no change, awakens person at night
12
Q
What are the characteristics of SYSTEMIC pain pertaining to PATTERN?
A
Although constant, may come in waves
Gradually progressive, cyclical
Night pain
- Location: Chest and shoulder
- Accompanied by shortness of breath, wheezing
- Eating alters symptoms
- Sitting up relieves symptoms (decreases venous return to the heart: possible pulmonary or cardiovascular etiology)
Symptoms unrelieved by rest or change in position
Migration arthralgias (pain/symptoms last for 1 week in 1 joint, then resolve and appear in another joint)
13
Q
What are the characteristics of SYSTEMIC pain pertaining to AGGRAVATING FACTORS?
A
Cannot alter, provoke, alleviate, eliminate, or aggravate the symptoms
Organ dependent (examples):
- Esophagus–eating or swallowing affects symptoms
- Heart–cold, exertion, stress, heavy feeling affects symptoms
- GI–peristalsis affects symptoms
14
Q
What are the characteristics of SYSTEMIC pain pertaining to RELIEVING FACTORS?
A
Organ dependent examples:
- Gallbladder–leaning forward may reduce symptoms
- Kidney–leaning to the affected side may reduce symptoms
- Pancreas–sitting upright or leaning forward may reduce symptoms
15
Q
What are the characteristics of SYSTEMIC pain pertaining to ASSOCIATED S&S?
A
Fever, chills
Sweats
Unusual vital signs
Warning signs of cancer
GI symptoms (nausea, vomiting, anorexia, unexplained weight loss, diarrhea, constipation)
Early satiety (feeling full after eating)
Bilateral symptoms (paresthesias, weakness, edema, nail bed changes, skin rash)
Painless weakness of muscles (more often proximal, but may occur distally)
Dyspnea (breathlessness at rest or after mild exertion)
Diaphoresis (excessive perspiration)
Headaches, dizziness, fainting
Visual disturbances
Skin lesions, rashes, or itching that the client may not associate with the musculoskeletal symptoms
Bowel/bladder symptoms
- Hematuria (blood in the urine)
- Nocturia
- Urgency (sudden need to urinate)
- Frequency
- Melena (blood in the feces)
- Fecal or urinary incontinence
- Bowel smears
16
Q
What are the characteristics of MUSCULOSKELETAL pain pertaining to ONSET?
A
May be sudden or gradual, depending on history
- SUDDEN–usually associated with acute overload stress, traumatic event, repetitive motion; can occur as a side effect of some meds (statins)
- GRADUAL–secondary to chronic overload of the affected part; may be present off and on for years
17
Q
What are the characteristics of MUSCULOSKELETAL pain pertaining to DESCRIPTION?
A
Usually unilateral
May be stiff after prolonged rest, but pain level decreases
Achy, cramping pain
Local tenderness to pressure is present
18
Q
What are the characteristics of MUSCULOSKELETAL pain pertaining to INTENSITY?
A
May be mild to severe
May depend on the person’s anxiety level–the level of pain may increase in a client fearful of a “serious” condition
19
Q
What are the characteristics of MUSCULOSKELETAL pain pertaining to DURATION?
A
Can be modified by rest or change in position
May be constant but is more likely to be intermittent, depending on the activity or the position
20
Q
What are the characteristics of MUSCULOSKELETAL pain pertaining to PATTERN?
A
Restriction of active/passive/accessory movements observed
One or more particular movements “catch” the patient and aggravate pain
21
Q
What are the characteristics of MUSCULOSKELETAL pain pertaining to AGGRAVATING FACTORS?
A
Altered by movement; pain may become worse with movement or some myalgia decreases with movement
22
Q
What are the characteristics of MUSCULOSKELETAL pain pertaining to RELIEVING FACTORS?
A
Symptoms reduced or relieved by rest or change in position
Muscle pain is relieved by short periods of rest without resulting stiffness, except in the case of fibromyalgia; stiffness may be present in older adults
Stretching
Heat, cold
23
Q
What are the characteristics of MUSCULOSKELETAL pain pertaining to ASSOCIATED S&S?
A
Usually none, although stimulation of trigger points (TrPs) may cause sweating, nausea, blanching
24
Q
What are all the possible SOURCES of pain?
A
Cutaneous Deep somatic Visceral Neuropathic Referred
25
What are all the possible TYPES of pain?
Tension
Inflammatory
Ischemic
Myofascial pain
- Muscle tension
- Muscle spasm
- Trigger points (TrPs)
- Muscle deficiency (weakness and stiffness)
- Muscle trauma
Joint pain
- Drug induced
- Chemical exposure
- Inflammatory bowel disease
- Septic arthritis
- Reactive arthritis
Radicular pain
Arterial, pleural, tracheal
Gastrointestinal pain
Pain at rest
Night pain
Pain with activity
Chronic pain
26
What are all the possible CHARACTERISTICS/PATTERNS of pain?
Client describes:
- Location/onset
- Description
- Frequency
- Duration
- Intensity
Therapist recognizes the pattern:
- Vascular
- Neurogenic
- Musculoskeletal/spondylotic
- Visceral
- Emotional
27
What conditions cause CENTRAL neuropathic pain?
Multiple sclerosis (MS)
Headache (migraine)
Stroke
Traumatic brain injury (TBI)
Parkinson's disease
Spinal cord injury (incomplete)
28
What conditions cause PERIPHERAL neuropathic pain?
Trigeminal neuralgia (Tic douloureux)
Poorly controlled diabetes mellitus (metabolic-induced)
Vincristine (drug-induced, used in cancer treatment)
Isoniazid (drug-induced, used to treat tuberculosis)
Amputation (trauma)
Crush injury/brachial avulsion (trauma)
Herpes zoster (shingles, postherpetic neuralgia)
Complex regional pain syndrome (causalgia)
Nerve compression syndromes (carpal tunnel syndrome, thoracic outlet syndrome)
Paraneoplastic neuropathy (cancer-induced)
Cancer (tumor infiltration/compression of nerve)
Liver or biliary impairment (liver cancer, cirrhosis, primary biliary cirrhosis)
Leprosy
Congenital neuropathy (porphyria)
Guillain-Barre syndrome
29
What are the risk factors for rhabdomyolysis as far as trauma?
Crush injury
Electrical shock
Severe burns
Extended mobility
30
What are the risk factors for Rhabdomyolysis?
Trauma
Extreme muscular activity
Toxic effects
Metabolic abnormalities
Medication-induced
31
What are examples of TRAUMA associated with Rhabdomyolysis?
Crush injury
Electrical shock
Severe burns
Extended mobility
32
What are the S&S of TRAUMATIC Rhabdomyolysis?
Profound muscle weakness
Pain
Swelling
Stiffness and cramping
Associated S&S
- Reddish-brown urine (myoglobin)
- Decreased urine output
- Malaise
- Fever
- Sinus tachycardia
- Nausea, vomiting
- Agitation, confusion
33
What are examples of EXTREME MUSCULAR ACTIVITY associated with Rhabdomyolysis?
Strenuous exercise
Status epilepticus
Severe dystonia
34
What are examples of TOXIC EFFECTS associated with Rhabdomyolysis?
```
Ethanol
Ethylene glycerol
Isopropanol
Methanol
Heroin
Barbiturates
Methadone
Cocaine
Tetanus
Ecstasy (street drug)
Carbon Monoxide
Snake venom
Amphetamines
```
35
What are examples of METABOLIC ABNORMALITIES associated with Rhabdomyolysis?
Hypothyroidism
Hyperthyroidism
Diabetic ketoacidosis
36
What are examples of MEDICATION-INDUCED causes of Rhabdomyolysis?
Inadvertent IV infiltration (e.g. amphotericin B, azathioprine, cyclosporine)
Cholesterol-lowering statins (Zocor, Lipitor, Crestor)
37
What are the SYSTEMIC causes of joint pain?
Allergic reactions (meds such as antibiotics)
Side effect of medications such as statins, prolonged use of corticosteroids, aromase inhibitors
Delayed reaction to chemicals or environmental factors
Sexually transmitted infections (STIs) such as HIV, syphilis, chlamydia, gonorrhea)
Infectious arthritis
Infective endocarditis
Recent dental surgery
Lyme disease
Rheumatoid arthritis
Other autoimmune disorders (systemic lupus erythematosus, mixed connective tissue disease, scleroderma, polymyositis)
Leukemia
Tuberculosis
Acute rheumatic fever
Chronic liver disease (hepatic osteodyst. affecting wrists & ankles; hepatitis causing arthralgias)
Inflammatory bowel disease (Crohn’s disease or regional enteritis)
Anxiety or depression (Major depressive disorder)
Fibromyalgia
Artificial sweeteners
38
What is included in the CLINICAL PRESENTATION of SYSTEMIC joint pain?
Awakens at night
Deep aching, throbbing
Reduced by pressure
Constant or waves/spasm
Cyclical, progressive symptoms
39
What is included in the PAST MEDICAL HISTORY of SYSTEMIC joint pain?
Recent history of infection
History of bone fracture, joint replacement, or arthroscopy
History of human bite
Sore throat, headache with fever in the last 3 weeks or family/household member with recently diagnosed strep throat
Skin rash (infection, medications)
Recent medications (last 6 weeks); any drug, but especially statins (cholesterol lowering), antibiotics, aromatase inhibitors, chemotherapy
Hormone associated (Post-menopausal status, low estrogen levels)
History of injection drug use/abuse
History of allergic reactions
History of GI symptoms
Recent history of enteric or venereal infection or new sexual contact (Reiter’s)
Presence of extensor surface nodules
40
What is included in the ASSOCIATED S&S of SYSTEMIC joint pain?
Jaundice
Migratory arthralgias
Skin rash/lesions
Nodules (extensor surfaces)
Fatigue
Weight loss
Low grade fever
Suspicious or aberrant lymph nodes
Presence of GI symptoms
Cyclical, progressive symptoms
Proximal muscle weakness
41
What is included in the CLINICAL PRESENTATION of MUSCULOSKELETAL joint pain?
Decreases with rest
Sharp
Reduced by change in position
Reduced or eliminated when stressful action is stopped
Restriction of active and passive ROM
Restriction of accessory motions
1 or more movements “catch,” reproducing or aggravating pain/symptoms
42
What is included in the PAST MEDICAL HISTORY of MUSCULOSKELETAL join pain?
Repetitive motion
Arthritis
Static postures (prolonged)
Trauma (including domestic violence)
43
What is included in the ASSOCIATED S&S of MUSCULOSKELETAL joint pain?
Usually none
Check for trigger points
TrPs may be accompanied by some minimal ANS phenomenon (e.g. nausea, sweating)
44
What are the screening questions to ask for joint pain?
Please describe the pattern of pain/symptoms from when you wake up in the morning to when you go to sleep at night?
Do you have any symptoms of any kind anywhere else in your body? (You may have to explain these symptoms don’t have to relate to the joint pain; if the client has no other symptoms, offer a short list including constitutional symptoms, heart palpitations, unusual fatigue, nail or skin changes, sores or lesions anywhere but especially in the month or on the genitals, and so forth)?
Have you ever had cancer of any kind, leukemia, Crohn’s disease, sexually transmitted infection, fibromyalgia, joint replacement or arthroscopic surgery of any kind?
Have you recently (last 6 weeks) had any fractures, bites (human/animal), antibiotics or other medications, infections, skin rashes or other skin changes?
Do you drink diet soda or use aspartame?
45
What are some other quick survey questions for joint pain?
What kind of work do you do?
Do you think your health problems are related to your work?
Are your symptoms better or worse when you’re at home or at work? (Do others at work have similar problems?)
Have you been exposed to dusts, fumes, chemicals, radiation, or loud noise?
Do you live near a hazardous waste site or any industrial facilities that give off chemical odors or fumes?
Do you live in a home built more than 40 years ago? Have you done any renovations or remodeling?
Do you use pesticides in your home, in your garden, or on your pets?
What is your source of drinking water?
Chronology of jobs? (type of industry, type of jobs, years worked)
How new is the building you now work in?
Exposure survey (protective equipment used, exposure to dust, radiation, chemicals, biologic hazards, physical hazards)
46
What are the risk factors for infectious arthritis?
A history of:
- Previous surgery, especially arthroscopy for joint repair or replacement
- Human bite, tick bite, fracture, central line placement
- Direct, penetrating trauma
- Infection of any kind
- RA, Lupus, scleroderma, mixed connective tissue disease
- Diabetes
- Sarcoidosis
- Sexually active, young adult
- Injection drug user
- Chronic joint damage (RA, gout)
- Previous infection of joint prosthesis
- Recent immunization
- Increased age
- Indwelling catheter (especially when prosthetic joint present)
- Malnutrition, skin breakdown
- Immunosuppression or immunocompromised
47
What are the clinical signs and symptoms of INFECTIOUS ARTHRITIS?
Fever (low-grade or high), chills, malaise
Recurrent sore throat
Lymphadenopathy
Persistent joint pain
Single painful swollen joint
Multiple joint involvement (often migratory)
Pain on weight-bearing
Back pain (infective endocarditis)
Skin lesions (characteristic of the specific underlying infection)
Conjunctivitis, uveitis
Other MSK sx depending on specific underlying infection:
- Myalgias
- Tenosynovitis (especially wrist
and ankle extensor tendon sheaths)
Elevated C-reactive protein and sedimentation rate
48
What are some screening questions for night pain?
Tell me about the pattern of your symptoms at night (open-ended)
Can you lie on that side? For how long? (does it wake you up when you roll onto that side?)
How are you feeling in general when you wake up? (Do you have any other symptoms when the pain wakes you up? Give the client time to answer before prompting with choices such as coughing, wheezing, SOB, nausea, need to go to the bathroom, night sweats)
Always ask the client reporting night pain of any kind (not just bone pain) the following screening questions:
- What makes it better, worse?
- What happens to your pain when you sit up? (Upright posture reduces venous return to the heart; decreased pain when sitting up may indicate cardiopulmonary cause)
- How does taking aspirin affect your pain/symptoms? (Disproportionate pain relief can occur using aspirin in the presence of bone cancer)
- How does eating or drinking affecting your pain/symptoms
- Does taking an antacid such as Tums change your pain/symptoms? (Check vital signs)
49
What are the AGS Recommendations for chronic pain assessment in the geriatric population?
All older clients should be assessed for signs of chronic pain
Use alternate words for pain when screening older clients (burning, discomfort, aching, sore, heavy, tight)
Contact caregiver for pain assessment in adults with cognitive or language impairments
Clients with cognitive or language impairments should be observed for non-verbal pain behaviors, recent changes in function, and vocalizations to suggest pain (irritability, agitation, withdrawal, gait changes, tone changes, nonverbal but vocal utterances such as groaning, crying, or moaning)
Follow AGS guidelines for comprehensive pain assessment including:
- Medical history
- Medication history, including current and previously used prescription and OTC drugs, as well as any nutraceuticals (natural products, “remedies”)
- Physical examination
- Review pertinent lab results and diagnostic tests (look for clues to the sequence of events leading to present pain complaint)
- Assess characteristics of pain (frequency, intensity, duration, pattern, description, aggravating and relieving factors); use a standard pain scale such as the visual analog scale
Observe neuromuscular (NMS) system for:
- Neurologic impairments
- Weakness
- Hyperalgesia; hyperpathia (exaggerated response to pain stimulus)
- Allodynia (skin pain to noxious stimulus)
- Numbness, paresthesia
- Tenderness, trigger points
- Inflammation
- Deformity
Pain that affects function or quality of life should be included in the medical problem list
50
What are ROM changes with systemic disease?
EARLY SCREENING:
Full and pain-free ROM
LATER SCREENING: Biomechanical response to pain results in changes associated with splinting or guarding
51
What are the PHYSICAL symptoms of anxiety and panic?
Increased sighing respirations
Increased BP
Tachycardia
Muscle tension
Dizziness
Lump in throat
Shortness of breath
Clammy hands
Dry mouth
Diarrhea
Nausea
Profuse sweating
Restlessness, pacing, irritability, trouble concentrating
Chest pain
Headache
Low back pain
Myalgia (muscle pain, tension, tenderness)
Arthralgia
Abdominal (stomach) distress
Irritable bowel syndrome (IBS)
52
What are the BEHAVIORAL symptoms of anxiety and panic?
Hyper-alertness
Irritability
Uncertainty
Apprehension
Difficulty with memory or concentration
Sleep disturbance
53
What are the COGNITIVE symptoms of anxiety and panic?
Fear of losing mind
Fear of losing control
54
What are the PSYCHOLOGIC symptoms of anxiety and panic?
Phobias
Obsessive-compulsive disorder (OCD)
55
What CARDIOVASCULAR conditions are commonly associated with depression?
Atherosclerosis
HTN
MI
Angioplasty/bypass surgery
56
What CNS conditions are commonly associated with depression?
Parkinson's disease
Huntington's disease
Cerebral arteriosclerosis
Stroke
Alzheimer's disease
Temporal lobe epilepsy
Post-concussion injury
Multiple Sclerosis
Miscellaneous focal lesions
57
What ENDOCRINE/METABOLIC conditions are commonly associated with depression?
Hyperthyroidism
Hypothyroidism
Addison's disease
Cushing's disease
Hypoglycemia
Hyperglycemia
Hyperparathyroidism
Hyponatremia
Diabetes
Pregnancy (postpartum)
58
What VIRAL conditions are commonly associated with depression?
AIDS
Hepatitis
Pneumonia
Influenza
59
What NUTRITIONAL conditions are commonly associated with depression?
Folic acid deficiency
Vitamin B6 deficiency
Vitamin B12 deficiency
60
What IMMUNE conditions are commonly associated with depression?
Fibromyalgia
Chronic fatigue syndrome
Lupus
Sjogren's syndrome
RA
Immunosuppresssion (Corticosteroid treatment)
61
What CANCER conditions are commonly associated with depression?
Pancreatic
Bronchogenic
Renal
Ovarian
62
What MISCELLANEOUS conditions are commonly associated with depression?
Pancreatitis
Sarcoidosis
Syphilis
Porphyria
Corticosteroid treatment
63
What drugs are commonly associated with depression?
Anxiety medications (Valium, Xanax)
Illegal drugs (cocaine, crack)
Antihypertensive drugs (beta blockers, anti-adrenergics)
Cardiovascular medications (digitoxin, digoxin)
Antineoplastic agents (vinblastine)
Opiate analgesics (morphine, Demerol, Darvon)
Anticonvulsants (Dilantin, phenobarbital)
Corticosteroids (prednisone, cortisone, dexamethasone)
NSAIDs
Alcohol
Hormone replacement therapy and oral contraceptives
64
What are the GENERAL effects depression causes?
Persistent fatigue
Insomnia, sleep disturbance
**Clinical signs and symptoms
65
What are the CARDIOVASCULAR effects depression causes?
Chest pain
- Associated with MI
- Can be atypical chest pain not associated with CAD
66
What are the GI effects depression causes?
IBS
Esophageal dysmotility
Nonulcer dyspepsia
Functional abdominal pain (heartburn)
67
What are the NEUROLOGIC effects depression causes?
Paresthesias
Dizziness
Difficulty concentrating and making decisions; problems with memory
68
What are the MUSCULOSKELETAL effects depression causes?
Weakness
Fibromyalgia
Myofascial pain syndrome
Chronic back pain
69
What are the IMMUNE effects depression causes?
Multiple allergies
Chemical hypersensitivity
Autoimmune disorders
Recurrent or resistent infections
70
What are the DYSREGULATION effects depression causes?
Automatic instability:
- Temperature intolerance
- BP changes
Hormonal dysregulation
Migraine and tension headaches
71
What are the OTHER effects depression causes?
SOB associated with asthma/not clearly explained at times
Anxiety or panic disorder
72
What are the S&S of depression?
Persistent sadness, low mood, feelings of emptiness
Frequent or unexplained crying spells
A sense of hopelessness
Feelings of guilt or worthlessness
Problems sleeping
Loss of interest or pleasure in ordinary activities/loss of libido
Fatigue or decrease in energy
Appetite loss (or over-eating)
Difficulty in concentrating, remembering, and making decisions
Irritability
Persistent joint pain
Headache
Chronic back pain
Bilateral neurologic symptoms of unknown cause (numbness, dizziness, weakness)
Thoughts of death or suicide
Pacing and fidgeting
Chest pain and palpitations
73
What are the S&S of panic disorder?
Racing or pounding heartbeat
Chest pains and/or palpitations
Dizziness, light-headedness, nausea
Headaches
Difficulty breathing
Bilateral numbness or tingling in nose, cheeks, lips, fingers, toes
Sweats or chills
Hand wringing
Dream-like sensations or perceptual distortions
Sense of terror
Extreme fear of losing control
Fear of dying
74
What tools can you use for emotional overlay?
McGill Pain Questionnaire (MPQ)
Symptom magnification and illness behavior
Waddell's non-organic signs
75
What are the SIGNS of Waddell's non-organic TENDERNESS?
SUPERFICIALLY-- client's skin tender to light pinch over a wide area of lumbar skin, unable to localize to one structure
NON-ANATOMIC-- deep tenderness felt over a wide area, not localized to one structure; crosses multiple somatic boundaries
76
What are the SIGNS of Waddell's non-organic SIMULATION TESTS?
AXIAL LOADING-- light vertical loading over client's skull in standing position reproduces lumbar spine pain
ACETABULAR ROTATION-- lumbosacral pain from upper trunk rotation, back pain reported when pelvis and shoulder are passively rotated in the same plane as the patient is standing, consider it a positive test if pain aries in first 30 degrees
77
What are the SIGNS of Waddell's non-organic DISTRACTION TESTS?
STRAIGHT LEG RAISE DISCREPANCY-- marked improvement of SLR when client is distracted as compared with formal testing; different response to SLR in supine (worse) compared with seated (better) when both tests should have the same result in the presence of organic pathology
DOUBLE LEG RAISE-- when both legs are raised after SLR, organic response would be of a greater degree; patients with nonorganic component demonstrate less double leg raise as compared with SLR
78
What are the SIGNS of Waddell's non-organic REGIONAL DISTURBANCES?
WEAKNESS-- cog-wheeling or giving way of many muscle groups that cannot be explained on a neurologic basis
SENSORY-- diminished sensation fitting a "stocking" rather than a dermatomal pattern
79
What are the SIGNS of Waddell's non-organic OVERREACTION?
Disproportionate verbalization, facial expression, muscle tension, tremor, collapsing, or sweating
Patient may exhibit any of the following behaviors during the physical examination:
- Guarding
- Bracing
- Rubbing
- Sighing
- Clenching teeth
- Grimacing
80
What are Waddell's non-anatomic or behavioral description of symptoms?
Pain at the tip of the tailbone
Whole leg pain from groin down to below knee in a stocking pattern (intermittent)
Whole leg numbness or whole leg "going dead" (intermittent)
Whole leg giving-way or collapsing (intermittent, patient still maintains upright position)
Constant pain for years on end without relief
Unable to tolerate any treatment, reaction or side-effects to any intervention
Emergency admission to hospital for back pain without precipitating traumatic event
81
What are the S&S of conversion disorder?
Sudden, acute onset
Lack of concern about the symptoms
Unexplainable motor or sensory function impairment
MOTOR:
- Impaired coordination or balance and/or bizarre gait pattern
- Paralysis or localized weakness
- Loss of voice, difficulty swallowing, sensing a lump in throat
- Urinary retention
SENSORY:
- Altered touch or pain sensation (paresthesia or dysesthesia)
- Visual changes (double vision, blindness, black spots)
- Hearing loss (mild to profound deafness)
- Hallucinations
- Seizures or convulsions
- Absence of significant lab findings
- Electrodiagnostic testing within normal limits
- Deep tendon reflexes within normal limits
82
What are the screening questions for psychogenic source of symptoms?
Do you have trouble sleeping at night?
Do you have trouble focusing during the day?
Do you worry about finances, work, or life in general?
Do you feel a sense of dread or worry without cause?
Do you ever feel happy?
Do you have a fear of being in groups of people? Fear of flying? Fear of public speaking?
Do you have a racing heart, unexplained dizziness, or unexpected tingling in you face or fingers?
Do you wake up in the morning with your jaw clenched or feeling sore muscles and joints?
Are you irritable or jumpy most of the time?
83
What is the best follow-up question for someone who tells you that the pain is constant?
Do you have that pain right now?
84
A 52-year-old woman with shoulder pain tells you that she has pain at night that awakens her. After asking a series of follow-up questions, you are able to determine that she had trouble falling asleep because her pain increases when she goes to bed. Once she falls asleep, she wakes up as soon as she rolls onto that side. What is the most likely explanation for this behavior?
The minimal distractions heighten a person's awareness of musculoskeletal discomfort
85
Referred pain patterns associated with impairment of the spleen can produce musculoskeletal symptoms in:
The left shoulder (Kehr's sign)
86
True of false?
Associated S&S are a major red flag for pain of a systemic or visceral origin compared to musculoskeletal pain.
True
| Table 3-2
87
Words used to describe neurogenic pain often include:
Crushing
Shooting
Pricking
88
Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of:
Neoplasm
89
Joint pain can be a reactive, delayed, or allergic response to:
Medications
Chemicals
Infections
Artificial Sweeteners
90
Bone pain associated with neoplasm is characterized by:
Increase with weight-bearing
91
True or false?
Pain of a viscerogenic nature is not relieved by a change in position.
False
Some can be
92
True or false?
Referred pain from the viscera can occur alone but is usually preceded by visceral pain when an organ is involved.
True
93
A 48-year-old man presented with low back pain of unknown cause. He works as a carpenter and says he is very active, has work-related mishaps (accidents and falls), and engages in repetitive motions of all kinds using his arms, back, and legs. The pain is intense when he has it, but it seems to come and go. He is not sure if eating makes his pain better or worse. He has lost his appetite because of the pain. After conducting and examination including a screening exam, the clinical presentation does not match the expected pattern for a musculoskeletal or neuromuscular problem. You refer him to a physician for medical testing. You find out later that he had pancreatitis.
What is the most likely explanation for this pain pattern?
Obstruction, irritation, or inflammation of the body of the pancreas distends the pancreas, thus applying pressure on the central respiratory diaphragm
