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Umesh
PAIN
Definition:
“An unpleasant sensory & emotional experience associated with actual or potential tissue damage, or
described in terms of such damage” – (Merskey 1990)
(The International Association for the Study of Pain)
PAIN THEORIES
Pre-Cartesian:
Cartesian model
Post - Cartesian development
PAIN HISTORY:
“PAIN – format”
Pattern: onset & duration
Area: location of pain
Intensity: level or severity
Nature: description of pain
“OPQRST – format”
Onset: sudden/insidious/gradual…
Provocation/precipitating factors: any particular posture/activity or others
Quality of pain: aching (impingement), burning (nerve irritation), sharp (acute injury), radiating (nerve root)
Relieving factors: what makes intensity of pain less/absent?
Site: of pain (anatomical location)
Temporal variation: when does pain occur morning/evening/ or after activity / all time
PAIN MEASUREMENT:
Measuring pain intensity:
1. Visual analog scale-
The client rates the pain on a continuum that begins with ‘no pain’ & ends with ‘max pain tolerable’.
3. Pain estimate:
0 100
4. Numerical pain rating scale:
6. Pain diary:
Localizing pain symptoms:
Pain Drawings
CLIENT EVALUATION:
Inspection:
Palpation:
Movements: Active/Passive
End feel:
ROM – analysis:
Manual muscle testing:
Resisted isometric testing:
Special tests: as relevant
Assessment of neurological function:
Investigations: as required
MANAGEMENT
Reference:
1. Pain textbook for therapists: Jenny Strong, Patrick Wall.
2. Umphred DA. Neurological Rehabilitation.
3. O’Sullivan: Physical Rehabilitation
4. Low Ann Reed: Electrotherapy Explained. Principles & Practice