Pain Types and Viscerogenic Pain Pattern PDF

Pain types and Viscerognic Pain Pattern Goodman and Snyder’s Differential Diagnosis for Physical Therapists: Screening for Referral. 7th edition, 2022 Chapter 3  Introduction Pain: an unpleasant sensory and emotional experience Pain is often the pr...

Pain types and Viscerognic Pain Pattern Goodman and Snyder’s Differential Diagnosis for Physical Therapists: Screening for Referral. 7th edition, 2022 Chapter 3  Introduction Pain: an unpleasant sensory and emotional experience Pain is often the primary symptom in patients and clients who access physical therapy services. Pain is recognized as the “Fifth vital sign,” along with blood pressure, temperature, pulse, and respiration. Recognizing pain patterns that are characteristic of systemic disease is a necessary step in the screening process. Mechanisms of Referred Visceral Pain Visceral Pain: Dull pain that is originated from the internal organs Mechanisms of Referred Visceral Pain:  Embryologic development  Multisegmental innervation  Direct pressure and shared pathways Mechanisms of Referred Visceral Pain - Embryologic development Mechanisms of Referred Visceral Pain - Multisegmental innervation Mechanisms of Referred Visceral Pain - Direct Pressure and Shared Pathways Assessment of Pain and Symptoms Pain measurement: assigning a number or value to give dimension to pain intensity. Pain assessment: includes a detailed health history, physical examination, medication history, assessment of functional status, and consideration of psychosocial-spiritual factors. Please refer to the reading material (Fig. 3.6) for more details  Characteristics of Pain Location Description of sensation Intensity Duration Frequency Pattern Aggravating and reliving factors  Location of Pain Questions related to the location of pain focus the client’s description as precisely as possible:  Show me exactly where your symptom/s is/are located.  Do you have any other symptoms anywhere else?  If yes, what causes the symptoms to occur in this other area? If the client points to a small, localized area and the pain does not spread, the cause is likely to be a superficial lesion and is probably not severe. If the client points to a small, localized area but the pain does spread, this is more likely to be a diffuse, segmental, referred pain that may originate in the viscera or deep somatic structure.  Description of Pain Pain Description  Knife-like  Dull  Boring  Burning  Throbbing  Prickly  Deep aching  Sharp  Description of Pain When a client describes the pain as knife-like, boring, colicky, coming in waves, or a deep aching feeling, this should be a signal to the physical therapist to consider the possibility of a systemic origin of symptoms. Dull, somatic pain of an aching nature can be differentiated from the aching pain of a muscular lesion by squeezing or pressing the muscle overlying the area of pain. Resisting motion of the limb may also reproduce aching of muscular origin that has no connection to deep somatic aching. Intensity of Pain A pain rating scale may be used to assess pain intensity.  Frequency and Duration of Pain Questions can be asked:  How long do the symptoms last? For example, pain related to systemic disease has been shown to be a constant rather than an intermittent type of pain experience. Clients who indicate that the pain is constant should be asked:  Do you have this pain right now?  Did you notice these symptoms this morning immediately when you woke up? Pattern of Pain Pattern of Pain Pain patterns of the chest, back, shoulder, scapula, pelvis, hip, groin, and sacroiliac (SI) joint are the most common sites of referred pain from a systemic disease process.  Sources of Pain Sources of Pain:  Cutaneous  Somatic  Visceral  Neuropathic  Referred  Sources of Pain - Cutaneous Cutaneous pain (related to the skin) includes superficial somatic structures located in the skin and subcutaneous tissue. The pain is well localized as the client can point directly to the area that “hurts.” Skin pain or tenderness can be associated with referred pain from the viscera or from deep somatic structures.  Sources of Pain - Somatic Somatic pain can be superficial or deep. Somatic pain is labeled according to its source as deep somatic, somatovisceral, somatoemotional (psychosomatic), or viscero-somatic. Superficial somatic structures involve the skin, superficial fasciae, tendon sheaths, and periosteum. Deep somatic: periosteum and cancellous (spongy) bone, nerves, muscles, tendons, ligaments, and blood vessels. Somatic referred pain is usually reported as dull, aching, and diffuse to localize. There are no neurologic signs associated with somatic referred pain  Sources of Pain - Visceral Visceral sources of pain include all body organs located in the trunk or abdomen, such as those of the respiratory, digestive, urogenital, and endocrine systems, the spleen, the heart, and the great vessels. Visceral pain tends to be poorly localized and diffuse. Visceral diseases of the abdomen and pelvis are more likely to refer pain to the back. Intrathoracic disease refers pain to the shoulder(s).  Sources of Pain - Neuropathic Neuropathic pain results from damage or pathophysiologic changes of the peripheral or central nervous system. Neuropathic pain can be acute or chronic. Neuropathic pain is not elicited by the stimulation of nociceptors or kinesthetic pathways Neuropathic pain is usually described as sharp, shooting, burning, tingling, or producing an electric shock sensation.  Sources of Pain - Referred Pain Referred pain can occur alone or with accompanying deep somatic or visceral pain. Referred pain is usually well localized (i.e., the client can point directly to the area that hurts), but it does not have sharply defined borders. It can spread or radiate from its point of origin. Comparison of Systemic Versus Musculoskeletal Pain Patterns Please refer to reading materials, Fig. 3.2 Characteristics of Viscerogenic Pain Gradual, Progressive, and Cyclical Pain Patterns Constant Pain Physical Therapy Intervention “Fails” Pain Does Not Fit the Expected Pattern  Guidelines for Immediate Physician Referral Any patients with risk factors for and clinical signs and symptoms of rhabdomyolysis (muscles breaking-down). Patients reporting a disproportionate relief of bone pain with a simple aspirin may have bone cancer. Joint pain with no known cause and a recent history of infection of any kind.  Guidelines for Physician Referral Required Proximal muscle weakness accompanied by change in one or more deep tendon reflexes in the presence of a previous history of cancer. Joint pain of unknown cause who presents with recent or current skin rash or recent history of infection (hepatitis, mononucleosis, urinary tract infection, upper respiratory infection, STI, streptococcus). Diffuse pain that characterizes some diseases of the nervous system and viscera. The therapist may screen for signs and symptoms of anxiety, depression, and panic disorder.  Guidelines for Physician Referral Required Patients with new onset of back, neck, TMJ, shoulder, or arm pain brought on by a new exercise program or by exertion with the arms raised overhead should be screened for signs and symptoms of cardiovascular impairment. Persistent pain on weight bearing or bone pain at night, especially in the older adult with risk factors such as osteoporosis, postural hypotension leading to falls, or previous history of cancer.