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Differential Diagnosis > Pain Lecture > Flashcards

Pain Lecture Flashcards

1
Q

What are the four sources of pain?

A

Cutaneous (somatic)

Deep somatic

Visceral

Referred

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2
Q

What are the characteristics of cutaneous pain?

A

Refers to pain along the skin

Localized with one finger

Associated with referred or deep somatic pain but again, localized

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3
Q

What are the characteristics of deep somatic pain

A

Bone, nerve, muscle, tendon, ligament, arteries, joints, spongy or cancellous bone, periosteum

Poorly localized

Often referred

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4
Q

What are the characteristics of visceral pain?

A

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

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5
Q

What are the characteristics of referred pain?

A

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

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6
Q

What are the mechanisms of referred visceral pain?

A

Embryologic development

Multisegmental innervation

Direct pressure and shared pathways

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7
Q

What are the possible visceral pathologies with pain in the RIGHT SHOULDER?

A

Liver

Perforated duodenal ulcer

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8
Q

What are the possible visceral pathologies with pain in the RIGHT POSTERIOR AXILLA?

A

Penetrating duodenal ulcer

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9
Q

What are the possible visceral pathologies with pain in the MIDDLE POSTERIOR BACK?

A

Penetrating duodenal ulcer

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10
Q

What are the possible visceral pathologies with pain in the RIGHT POSTERIOR FLANK?

A

Cholecystitis

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11
Q

What are the possible visceral pathologies with pain in the LOW BACK?

A

Pancreatitis

Renal colic

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12
Q

What are the possible visceral pathologies with pain in the SACRUM?

A

Rectal lesions

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13
Q

What are the possible visceral pathologies with pain in the LEFT POSTERIOR SHOULDER?

A

Pancreatitis

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14
Q

What are the possible visceral pathologies with pain OVER LEFT BREAST, MEDIAL ARM?

A

Heart

GERD

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15
Q

What are the possible visceral pathologies with pain UNDER RIGHT BREAST?

A

Biliary colic

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16
Q

What are the possible visceral pathologies with pain in the RIGHT UPPER ABDOMEN?

A

Cholecystitis

Pancreatitis

Duodenal ulcer

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17
Q

What are the possible visceral pathologies with pain UNDER LEFT BREAST?

A

Peptic ulcer

Renal ulcer

18
Q

What are the possible visceral pathologies with pain in the RIGHT LOWER ABDOMEN (Erb’s point)?

A

Appendicitis

19
Q

What are the possible visceral pathologies with pain OVER THE NAVAL?

A

Small intestine

Appendicitis

20
Q

What are the possible visceral pathologies with pain OVER THE PUBIC REGION?

A

Colon

21
Q

What are the possible visceral pathologies with pain in the LEFT GROIN?

A

Ureteral colic

22
Q

What are the possible visceral pathologies with pain in the SHOULDER AND LOW BACK?

A

Diaphragm

23
Q

What are the possible visceral pathologies with pain in the SHOULDER, NECK, UPPER BACK, and GENITALIA?

A

Urogenital tract

24
Q

What are the possible visceral pathologies with pain in the SHOULDER, MIDTHORACIC/LOW BACK?

A

Pancreas

Liver

Spleen

Gall bladder

25
Q

If you have a lesion at C7 or between T1 and T5, what somatic representation of that pain should be expected?

A

Pain in inter-scapular area

Pain in posterior shoulder

26
Q

If you have a lesion at the shoulder, what somatic representation of that pain should be expected?

A

Pain in neck

Pain in upper back

27
Q

If you have a lesion at L1 or L2, what somatic representation of that pain should be expected?

A

Pain in the SI joint

Pain in hip

28
Q

If you have a lesion in the hip joint, what somatic representation of that pain should be expected?

A

Pain in SI joint

Pain in knee

29
Q

If you have a lesion around the pharynx, what somatic representation of that pain should be expected?

A

Pain in the ipsilateral ear

30
Q

If you have a lesion at the TMJ, what somatic representation of that pain should be expected?

A

Pain in the head

Pain in the neck

Pain in the heart

31
Q

What are the characteristics of pain that your patient will disclose to you?

A

Location/onset

Description

Intensity

Duration

Frequency

32
Q

As far as PATTERN with pain goes, what are the things you are assessing?

A

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

33
Q

As far as the AGGRAVATING/RELIEVING FACTORS with pain go, what are the things you are assessing?

A

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)

34
Q

What are the various positions to relieve pain when speaking of pain from ORGANS?

A

RELIEVING:
Gallbladder–lean forward
Kidney–lead to affected side
Pancreas–sit upright/lean forward

AGGREVATING:
Esophagus–swallowing
GI–peristalsis (eating)
Heart–cold/exertion/stress

35
Q

What are some things to consider with NIGHT PAIN?

A

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

36
Q

What are the 5 types of MYOFASCIAL PAIN?

A

Trauma

Muscle spasm

Muscle tension

Muscle deficiency

Trigger points (TrPs)

37
Q

What are some things to know about trigger points?

A

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
38
Q

What are three things that you want to look at when screening for EMOTIONAL OVERLAY?

A

McGill Pain Questionnaire

Symptom magnification

Waddell’s nonorganic signs

39
Q

What is the McGill Pain Questionnaire?

A

Considered a good baseline for assessing pain

Has a high reliability and validity in younger populations–has not been tested in the old

40
Q

What is SYMPTOM MAGNIFICATION?

A

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

41
Q

What do you do with a NONORGANIC TEST SEQUENCE?

A

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

Differential Diagnosis (5 decks)

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