By Kimberly A. Sackheim
This entire e-book covers the data had to analysis and deal with sufferers with acute and persistent ache. Sections devoted to sufferer overview, medicine administration, treating sufferers with extra advanced conditions and interventional administration supply clinically-relevant info on an array of subject matters appropriate to either the generalist and professional. a few sections being prepared in a analysis established technique support to target those themes and function a short reference. a pragmatic and easy-to-use advisor, Pain administration and Palliative Care provides a huge starting place on soreness overview and administration and is a useful day-by-day better half for these coping with sufferers experiencing pain.
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Additional info for Pain Management and Palliative Care: A Comprehensive Guide
Tools for assessing neuropathic pain. PLoS Med. 2009;6(4):e1000045. 9. Passik SD, Kirsh KL. Screening for opioid abuse potential. Int Assoc Study Pain. 2008;16(7):1–4. 3 Physical Examination: Approach to the Pain Patient Jeremy J. Robbins, Fani J. Thomson, and Julia Sackheim Abbreviations AC ASIS ATFL DIP DTR EOMI FADIR MCP PERRLA PIP PROM PSIS ROM SI SLR TMJ Acromioclavicular Anterior superior iliac spine Anterior taloﬁbular ligament Distal interphalangeal Deep tendon reﬂex Extraocular muscles intact Flexion adduction internal rotation Metacarpophalangeal Pupils equal round reactive light Proximal interphalangeal Passive range of motion Posterior superior iliac spine Range of motion Sacroiliac Straight leg test Temporomandibular joint Muscle Strength Scale  (the Same Scale Is Used for each Section of the Physical Examination) • • • • • 0 = No contraction 1 = Visible muscle twitch but no movement of the joint 2 = Weak contraction insufﬁcient to overcome gravity 3 = Weak contraction able to overcome gravity 4 = Contraction able to overcome some resistance but not full resistance • 5 = Normal; able to overcome full resistance Deep Tendon Reflex (DTR) Grading Scale  • • • • • 0 = No observable reﬂex 1 = Trace reﬂex 2 = Normal reflex 3 = Very brisk increased reﬂex 4 = Clonus Introduction Physical examination is important as it helps to rule out serious pathology and can lead to a more focused treatment once etiology is established.
Babinski reflex: Tracing along the curvature of the sole, sweep the foot from heel to toe. A positive result is hallux extension, which indicates spinal cord lesion/ pathology in the cervical region . 12 Cervical spine pathology Diagnosis Cervical spondylosis Pain distribution Unilateral or bilateral Onset of pain Gradual Levels typically affected C5-C7 Cervical stenosis Cervical disk herniation Unilateral or bilateral Unilateral more commonly Gradual Sudden Varies C5-6 Thoracic Spine Examination • Inspection: Observe for scoliosis, kyphosis, asymmetry • Palpation: – Muscles: Paraspinals, rhomboids, supraspinatus, infraspinatus mucles – Bony Anatomy: Vertebral bodies, Spinous Processes, Facet joints, Ribs Flexion May decrease pain (pain can increase with extension) May decrease pain May increase pain • Range of motion: Passively and actively  • Sensation: See Fig.
Roach K, Miles T. Normal hip and knee active range of motion: the relationship to age. J Am Phys Ther Assoc. 1991;71(9):656–65. pdf. Accessed 5 Mar 2014. 10. Cuccurullo S. Physical medicine and rehabilitation board. New York: Demos Medical; 2010. 11. Malanga GA. Musculoskeletal physical examination. 1st ed. Philadelphia: Elsevier Mosby; 2006. 4 Diagnostic Imaging Paul Weyker, Christopher Webb, Isaac Wu, and Leena Mathew Abbreviations AP CPP CRPS CT MRI STIR TVUS US Anterioposterior Chronic pelvic pain Complex regional pain syndrome Computed tomography Magnetic resonance imaging Short-tau inversion recovery Transvaginal ultrasound Ultrasound Two types of risk with radiation: • Stochastic: – Affects probability of a condition – Severity will be dose independent – Examples are: fetal abnormalities, cancer and genetic effects • Non-stochastic (deterministic): – Effect has known threshold radiation dose: erythema, cataracts Plain X-Ray Introduction  Diagnostic radiology traces its origins to 1895 when Wilhelm Roentgen produced the ﬁrst X-ray image.