Pain
A. H&P
Location, quality, duration, intensity, aggravating and relieving factors, h/o trauma, disability, litigation, drugs tried, other treatments, imaging work, psychiatric history, strength, range of motion, straight leg raise, pin prick and light touch sensation, skin color and temperature, dystrophic skin changes.
B. Common MD false beliefs about pain
1. Masking: Pain meds dangerously mask important sx?
No—you can continue the workup with pt comfortable.
2. Physical signs: Pain correlates with VS, ability to sleep?
No—ANS activation varies widely.
3. Addiction: Addicts overreport pain because they are addicted?
No—opiate receptor downregulation physiologically worsens pain.
4. Dosing: In treating addicts, keep med doses as low as possible?
No—they have opiate tolerance, so need more.
5. Emotion: Pain only appears to worsen with stress?
No—it actually worsens it through physiological mechanisms.
6. Chief complaint-ism: Treat the true CC, whether pain or emotion?
No—treat both. Treat anxiety even when it is secondary. Conversely, pts. who irrationally fear a brain tumor may not let go of that until you treat their HA.
C. Common pt pain myths
Address these directly and sympathetically.
1. Masking: Pain meds dangerously mask my important sx. See above.
2. Fear of med dependence: Needing a med ≡ physical tolerance ≡ addiction. Explain the difference and that <1% of pts. who take meds for pain abuse them. But also ask if relatives have addictions.
3. Ignoring moodRelated posts:
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