Assessment of Pain (Exam I) Flashcards by Amanda M.

When gathering information we will use direct questions and rule out Red Flags. What are the red flags?

Bowel/bladder dysfunction
Saddle anesthesia (sphincter tone)
Bilateral leg weakness (motor deficit)
Severe sudden onset headache (ICH, stroke?)
Fever, weight loss, night sweats (cancer)
Recent injury
History of cancer

How well did you know this?

Not at all

Perfectly

How will cancer affect your anesthesia plan?

think about pain medication

How well did you know this?

Not at all

Perfectly

An assessment of persistent pain that is SOLELY focused on identifying the pain generator will likely lead to _____

Frustration for the patient and the provider

How well did you know this?

Not at all

Perfectly

The goal of the interview is to _____, ______ and ______

build trust
gather information
facilitate change

How well did you know this?

Not at all

Perfectly

OPQRSTU

Onset
Provocative/palliative
Quality or character
Region/radiation
Severity
Timing/treatment
U (you/impact on patient)

How well did you know this?

Not at all

Perfectly

What causes interviews to be confrontational?

doubt and frustration

How well did you know this?

Not at all

Perfectly

Mindfulness

nonjudgmental awareness of the present moment

How well did you know this?

Not at all

Perfectly

Self-awareness

awareness of our own emotions, thoughts, and body

How well did you know this?

Not at all

Perfectly

Chronic pain often leads patients to feel these 5 things

fearful
anxious
frustrated
angry
poor ability to self-regulate their emotions

How well did you know this?

Not at all

Perfectly

What are the components of the clinical exam? (8)

Posture/gait
Palation
Inspection/ general appearance
Mental status
Vital signs
Range of motion (active and passive)
Neurological exam
Special Tests

How well did you know this?

Not at all

Perfectly

Where is neck pain located?

Anywhere between the base of the skull and the first thoracic process

How well did you know this?

Not at all

Perfectly

Where is upper and lower neck pain defined?

How well did you know this?

Not at all

Perfectly

Neck pain can cause ____ pain or _____ headaches

arm;
cervicogenic

How well did you know this?

Not at all

Perfectly

Red Flags- N SWIFT PICS

Neuro- progressive neurological deficit

Steroids (long term)
Weight loss (unexplained)
Immunosuppression
Fever (unexplained)
Trauma

Porosis (osteoporosis/osteopenia)
IVDU (IV drug use)
Cancer
Severity of pain

How well did you know this?

Not at all

Perfectly

What converts acute pain to chronic pain other than time?

PTSD, anxiety, multiple injuries

How well did you know this?

Not at all

Perfectly

At what point is pain considered chronic?

3 months

How well did you know this?

Not at all

Perfectly

What is considered low back pain?

Anywhere between the tip of the last thoracic spinous process to the tip of the sacro-coccygeal joints

How well did you know this?

Not at all

Perfectly

Surgical Trauma

When the surgeon causes pain and trauma

How well did you know this?

Not at all

Perfectly

All pain has cognitive, sensory and emotional influences and behavioral manifestations. Meaning _______ influences the pain experience

spirituality

How well did you know this?

Not at all

Perfectly

_____ on a pain generator is often ineffective when treating chronic pain

Myopic focus (only focusing on the now)

How well did you know this?

Not at all

Perfectly

____ is associated with higher pain intensity, likelihood of developing chronic pain and poor treatment response

catastrophizing

How well did you know this?

Not at all

Perfectly

Pain Catastrophizing Scale examples: When I’m in pain I…

I worry all the time about whether the pain will end
It’s terrible and I think it’s never going to get any better
It’s awful and it feels like it overwhelms me
I become afraid the pain will get worse
There’s nothing I can do to reduce the intensity of the pain

How well did you know this?

Not at all

Perfectly

What can worsen chronic pain?

Psychiatric conditions
poor sleep

How well did you know this?

Not at all

Perfectly

What can be caused or worsened by opioid medications?

Sleep disordered breathing

How well did you know this?

Not at all

Perfectly

What increases likelihood of opioid misuse and abuse?

history of substance use disorder including tobacco

_______ is an emotional response in which the provider redirects their feelings, beliefs back onto the patient that can elicited by patients with chronic pain. It is only partially conscious, but always present

Countertransference

What is the goal of the physical exam?

to exclude red flags

Important findings in the physical exam include _____, ______ and _____

1. inflammatory/infectious arthritis 2. neurological deficits 3. evidence of systemic pathology

Trendelenburg Gait

drop of pelvis when lifting opposite leg to the weak

Foot Drop Cause

unilateral is commonly caused by peroneal nerve palsy or L5 radiculopathy

Motor Grading

5=normal 4=full ROM against resistance 3=full ROM against gravity 2=Full ROM w/gravity eliminated 1=palpable/observable contraction 0=no palpable contraction

_____ are muscle groups innervated by specific spinal nerve

myotomes

DTR grading

0= absent 1= diminished 2= normal 3= hyperactive 4= hyperactive with clonus

Pathological findings (Provocative findings)

- straight leg raise - Spurling's - Tinel's - Phalen's

In the absence of red glad signs and a normal physical exam, routine imaging ____ and _____ long-term outcome

1. reinforces sick behavior 2. worsens

Use diagnostic imagine only when _______ and _____ suggest ______

1. red flag sign 2. a physical exam 3. red flag condition

Advanced diagnostic imaging such as CT or MRI could be considered when ______

referring for interventional or surgical procedure

Do not image acute low back pain within the first 6 weeks unless

red flags are present

Do not image an uncomplicated headache unless (8)

1. neurologic exam abnormal 2. unable to diagnose with history and exam 3. HA is sudden or explosive 4. different from previous, especially over 50 y/o 5. progressively worsening 6. brought on by exertion 7. accompanied by fever, seizure, vomiting, loss of coordination, changes in vision, speech, alertness 8. immunocompromised or known malignancy

T/F. We measure pain intensity for chronic pain using the NRS or VRS

false.

_____ is the first line pain intensity scale, ____ is the second and ____ is the third

VRS (verbal rating scale) NRS (numeric raiting scale) combined VRS and NRS

What pain scale would be better for chronic pain

PEG. (Pain, enjoyment, and general activity scale)

what two things do the PEG scale not take into consideration?

sleep and stress

STOP-BANG screening

For sleep apnea Snoring? Tired? Observed apnea? P high blood pressure? BMI >35? Age>50? Neck circumference>40cm (16 in) Gender is male?

What score of STOP BANG has a high sensitivity for detecting OSA?

3 or more

What score of STOP BANG put patient of high probability of moderate/severe OSA

5-8

Diagnose and assess the severity of fibromyalgia using the ___ and ___

WPI (widespread pain index) symptom severity (SS) score

A score of ____ on the opioid risk tool is low risk, _____ is moderate risk and ___ is high risk

- 0-3: low - 4-7: moderate - 8 or more: high

What are the 4 (+2) A's to assess the effectiveness of your treatment?

1. Activity 2. Analgesia 3. Aberrant drug related behavior 4. Adverse effects 1. Affect 2. Adjunctions

The distribution for neck pain is _______, meaning it is muscle related

Myotomal

True/False: If osteoarthrosis is presumed to be the cause of chronic neck pain, it cannot be detected by imagine.

true

What does pain of flexion of neck indicate?

disc injury/pain

What does pain of extension of neck indicate?

facet injury/pain

pain that follows myotomes and is muscular in nature...has a normal neurological exam

referring

Pain that follows dermatomes and is nerve pain...has an abnormal neurological exam

radiating

Would you give a nerve block for radiating or referring pain?

Radiating

Most neck pain is ____

myofascial

Where can back pain refer to?

the lower extremity above and below the knee

Cauda Equina symptoms

saddle anesthesia loss of bowel/bladder

What is the common complaint with an abdominal aortic aneurysm?

"feels like my back is tearing" "something is stabbing me in the back"

What is generally the first line imaging?

X-ray

True or False: if osteopenia is in the back, it is everywhere

True: think of it like CV disease

How does Acupuncture provide pain relief?

lateral inhibition

What are the shoulder and pectoral girdle composed of?

scapula, clavicle, humerus

How are the shoulder and pectoral girdle stabilized?

rotator cuff

Where can shoulder pain be referred from?

neck, heart, gallbladder

Most common shoulder pain condition in eldery

osteoarthritis

What is imaging of choice for shoulders when indicated?

MRI

Hip pain is most common in ______. It can be generated from the hip or referred to/from ____, ____, _____ or _____

People over 60 -low back -thigh -booty -groin

Hip pain: Blood supply is most vulnerable at the _____. If there is a lack of blood flow here it can cause ____

femoral neck; avascular necrosis

The hips have ____ planes of direction with ____ motions each

3; 2

Favor Test

have patient sit and cross leg... put pressure on the knee which opens the SI joint - if there is pain...SI joint pain

Why are steroid injections not favorable for joint injections?

can cause avascular necrosis

What offer best long term results for hips?

exercise and patient activation

Where can knee pain refer to?

thigh, lower back, leg

Most acute knee injuries are _____ injuries. For imaging, follow ______

soft tissue; ottawa

Assessment of Pain (Exam I) Flashcards

(76 cards)