ASSESSMENT OF PAIN

Pain gives the body warning and often is accompanied by anxiety and the need to relieve the pain. Pain is both sensation and emotion. As noted earlier, it can be acute or chronic. Health-care professionals may find the following mnemonic tool useful for assessing a client in pain:

  • P = place (client points with one finger to the location of the pain)
  • A = amount (client rates pain on a scale from 0 [no pain] to 10 [worst pain possible])
  • I = interactions (client describes what worsens the pain)
  • N = neutralizers (client describes what lessens the pain)

The scale of 0 to 10, as described in the mnemonic, is a useful method of assessing pain. Further pain assessment skills include observing the client’s appearance and activity. Monitoring the client’s vital signs may be of value in assessing acute pain but not necessarily chronic pain.

READ:   Spine Health. PROCEDURE 13 — FLEXION IN LYING

To assess the pain of children or those with some cognitive dysfunction or dementia, a “smiley face” model often proves beneficial. The first smiley face shows a happy face with no pain or hurt, whereas the last face shows pain that “hurts worst.” Individuals are asked to point to the face that describes his or her smile. Note the faces are on a numeric scale.

Pain assessment scales for adults and children

FIGURE. Pain assessment scales for adults and children.

Spine Health. PROCEDURE 4 — EXTENSION IN LYING WITH BELT FIXATION The patient’s position and the exercise are the same as in the third procedure, but now a fixating belt is placed at or just below the segments to be extended. The safety belt is the first simple external aid, used to enhance maximum extension. It does so by preventing the pelvis and lumbar spine lifting from the couch. Other methods of restraint may be used effectively, for example the body weight of a young son or daughter when exercising at home. Fig. Extension in lying with belt fixation. Effects: This procedure creates a greater and more localised passive extension stress than the previous ones. It is particularly suitable for stretching in the case of extension dysfunction, and is more often required in dysfunction than in derangement. In dysfunction some pain will be experienced in the small of the back while exercising, because contracted tissues are being stretched. In derangement the rules pertaining to the centralisation phenomenon must be observed, and the proce...
Recovering From Acute Low Back Pain. General Instructions You have recovered from the acute episode because of your ability to master the exercises which relieved your pain. These exercises must be repeated whenever situations arise which have previously caused pain. You must perform the corrective movements before the onset of pain. This is essential. If you carry out the following instruction, you can resume your normal activities without the fear of recurrence. SITTING When sitting for prolonged periods the maintenance of the lordosis is essential. It does not matter if you maintain this with your own muscles or with the help of a supportive roll, placed in the small of your back. In addition to sitting correctly with a lumbar support, you should interrupt prolonged sitting at regular intervals. On extended car journeys you should get out of the car every hour or two, stand upright, bend backwards five or six times, and walk around for a few minutes. BENDING FORWARDS When engaged in activities which require prolonged fo...
EFFECTIVE PAIN MANAGEMENT According to the Agency for Healthcare Research and Quality (AHRQ), a federal agency established in 1989, there are three major barriers to effective pain management: the health-care system health-care professionals clients The health-care system is slow to hold itself accountable for assessing and relieving pain. Many professionals suggest that assessment of pain be included with the measurement of taking vital signs, such as temrerature, pulse, respiration, and blood pressure. Pain assessment would be the fifth vital sign. It is helpful to remember that heart rate and blood pressure may increase with acute pain but not necessarily with chronic pain. The belief is that routinely assessing and relieving pain would prove more cost effective than ignoring the issue. Health professionals are not always educated about the meaning of and assessment of pain management and may be concerned about the use of opioids (narcotics), mainly due to possible addiction. Clients and their fam...
Examination of Back Pain Having digested the information supplied by the referring doctor, extracted as much relevant information as possible from the patient, and checked the radiologist’s report, we may proceed to the examination proper. If the patient is able to do so, we should make him sit on a straight backed chair while taking his history. During this lime he will reveal the true nature of his sitting posture. When the patient rises to undress after the interrogation we should observe the way he rises from sitting, his gait, the way he moves, and any deformity that may be obvious. We will record the following: I. POSTURE SITTING If the patient has been sitting during history taking, we already have a good impression of his posture. We now ask him to sit on the edge of the examination table with his back unsupported. In the majority of cases the patient will sit slouched with a flexed lumbar spine. Some patients are more aware of the relationship between their posture and pain. They have discover...
Back Pain. Diagnosis THE THERAPIST’S RESPONSIBILITY The therapist is part of the team involved in the treatment and rehabilitation of patients suffering low back pain. In some countries manipulative therapists are primary contact practitioners. Consequently, their diagnostic skills have greatly improved, enabling them to define which mechanical conditions can be helped by mechanical therapy and to separate these conditions from the nonmechanical lesions which have no place in the therapy clinic. However, differential diagnosis is really not within the scope of manipulative therapy. It is my view that differential diagnosing by medical practitioners is necessary to exclude serious and unsuitable pathologies from being referred for mechanical therapy. In making diagnoses the manipulative therapist should confine himself to musculo-skeletal mechanical lesions. Specialised in this field, he is usually able to make far more accurate diagnoses than most medical practitioners. As the manipulative therapy prof...