pain Assessment .pdf

TOPIC 7: PAIN ASSESSMENT * original model Onset # Sudden or insidious Associated with trauma? If affirmative … -Any twinge (ligament) or clic...

TOPIC 7: PAIN ASSESSMENT * original model Onset # Sudden or insidious Associated with trauma? If affirmative … -Any twinge (ligament) or click (meniscus) perceived? -Was there immediate inflammation (outside) or deferred (inside)For how long did it last? If negative… 6 -What triggers the pain? -Associated with some concrete activity? E -Related to OVERUSE? Clinical features of Pain Neuropathic Pain Caused by irritation of the nerve roots and dorsal (sensory linked to hypoesthesia) ganglion. * High-intensity, throbbing, electrical , burning. Goes over the affected nerve tour (occasionally to fingertip) Occasional dysesthesia and/ or paresthesia. Somatic Pain - Dull, non-electric, diffuse and difficult location. Highly variable intensity. Distinguish differential aspects involving every affected tissue. Visceral Pain Deep and diffuse Often mislead with somatic pain. * Associated with viscera function Pain behaviour Continuous - Does not occur with specific positions or rest. Chemical irritation, bony tumor, visceral. If not increased with mechanical tests. Intermittent - Present or absent depending on its triggers. Mechanical if originated at the musculo-skeletal system. Persistent Constant with variations Inflammatory and mechanical shades  - - Tdisce Previous treatments Crucial to focus on a new treatment according to those made previously and prognosis establishment. * Signs or symptoms that may alert of major pathology: - Severe or Ominor trauma (if there is history of osteoporosis) ~ -History of cancer/tumours family) dat -Older than 50 or younger than 20 - -Recent infection - > -Fever -General - asthenia -Sudden weight loss -Immunosuppression -Night or constant pain not associated with clearly variation sin the relief -Saddle pareses or anesthesia o -Bilateral neurological symptoms involving the lower limb + back pain -Sudden decrease in muscle strength 2CN5 -Dorsal or lumbar pain associated with any particular- - food or diet Psychosocial factors that increase the risk of developing long-term disability -Belief —> “the injury is harmful” hinssophobic -Fear from specific movements and avoidance behaviours -Tendency to despair and social isolation > - older hroni and -Expectations that passive treatments are more helpful than the active training Objective assessment Visual inspection 1st phase —> Started in the 1st visual contact with the patient. P - Is he/she protecting the affected area? Technical aids to mobility? Family overprotection? Limping ? How does he/ she get undressed? -Skin colour info GAIrcycle -Postural standing -Muscle atrophy -Scar C different types -Deformities -Odemeas, bruises - Flexion wrinkles -Pupillary appearance Mobility and muscle strength exploration Active mobility & -Always before passive assessment -OJO —> The contractile component rules the whole examination -Physiological movements —> Combined movement scanning -Movement ⑳ Quality -Muscle testing if necessary —> to evaluate muscle strength and O pain during contraction u Passive Mobility Partive retainer O -Inert components of the musculoskeletal system -Physiological and accessory passive movements u Final movement sensation: # - sliding -CAPSULAR (I.e feeling of flexion of the wrist or knee extension) -OSSEOUS (sharp and irreducible) -ELASTIC (I.e dorsal flexion of ankle with the knee extended) -IN SPRING ( I.e#knee-fibrocartilage meniscal injury) -COMPRESSIVE (I.e maximum knee flexion) -THICK ( I.e capsular inflammation) -SPASM (I.e reactive response in the opposite direction to the movement) -VACUUM (I.e absence of final feeling, absence of reactive spasm) -HARD MECHANICAL ( jammed) Specificity Tests: -According to patient’s complaint and body region -Provocation tests, neurological study, osteoarthritis- tendinous reflexes Palpation: -At the end of the scan -Search for sensation, painful points, tissue temperature Finally 6 - - - (goals Clinical reasoning in Physical therapy “Mental process and decision making that takes place during the process of evaluation, diagnosis and treatment of the patient’s pathology”. Crucial to guarantee our true professional autonomy (PT’s are responsible for our own actions and are able to adopt responsible, timely, accurate, and independent clinical decisions) Initial models Hypothetical-deductive reasoning. -Based on the relationship between clinical patterns and diagnosis. Jones (1992) adapted the HDR and proposed a Category hypothesis system (shows numerous interrelated components of the patient’s condition; 7 categories) 1.Functional limitation or disability 2.Pathobiologic mechanisms 3.Physical and psychological disorders 4.Contributing factors 5.Precautions and contraindications 6.Management and treatment 7.Prognosis Collaborative Models Patient Centered Model -Highlights the importance of the patient specific problem context within the clinical reasoning process. -Depends on the W role of each patient in the decision-making process. W & Dialecting reasoning -Holystic less used [ plausible - -Faces thought and actions towards the understanding of the person, instead of only his/her physical problem u -“Interaction between quantitative and qualitative reasoning models” Collaborative Clinical Reasoning Model -Highlights the patient’s cooperation on the CR process. -Helps PTs to delve into the patient’s condition and patients to improve their understanding and condition acceptance, - in order to increase the therapeutic process efficiency. -This collaboration leads to the improvement of patient’s perspectives and treatment outcomes. Edwards (2000-2004) Diagnosis: Diagnostic reasoning —> Functional - impairments - Narrative reasoning —> Understand the patient’s - interpretation of his/her condition. z Treatment: un Reasoning of the & procedure —> Define therapeutic procedures O Interactive reasoning —> Establishment of the PT- patient relationship - m Collaborative reasoning —> PT- patient treatmentE - decision-making Teaching reasoning —># ~ Explanation of the PTP —> higher patient implication - Predictive reasoning —> take into accountS future shifts and their consequences. ~ TOPIC 7: PAIN ASSESSMENT V2 Nociception Encoding and processing of harmful stimuli in the nervous system. Nociceptor High threshold sensory receptor that is capable of transducing and encoding noxious stimuli. -Thermal -Mechanical -Chemical -Silent -Polimodal