II. History
- Onset of pain
- Events surrounding pain onset
- Precipitating factors
- Trauma
- Overuse
- Concurrent illness
- Date of onset
- Location and radiation of pain
- Characteristics of pain
- Neuropathic pain (Burning, stabbing or shooting pain)
- Musculoskeletal pain or Mechanical compression pain (Aching, soreness, stiffness)
- Inflammatory pain (Aching, swelling, hot, red)
- Grading of pain: Scale of 0 to 10 (10 is worst)
- See Pain Scale
- Impact of pain on level of functioning
- Provocative factors
- Palliative factors
- Current and past treatments for pain
- Comorbidities
- History of Substance Abuse
- Chronic medical conditions
III. Examination
-
General Examination Diagnostic Clues
- Fever
- Tachycardia or Arrhythmia
- Thyromegaly
- Proximal Muscle Weakness
- Joint inflammation
- Dermatitis
- Neurologic abnormalities
- Hepatomegaly or Splenomegaly
- Lymphadenopathy
- Focus on area of reported pain
- Observe patient's movement and Posture
- Observe for poor Posture (lumbar hyperlordosis)
- Consider poor work ergonomics
- Observe Muscle Strain and guarding
- Localize associated pain in other areas
- Observe for Leg Length Discrepancy
- Assess for Trigger Points (Myofascial Pain Syndrome)
- Assess for Tender Points (Fibromyalgia)
- Complete Neurologic Exam with Motor Strength testing
IV. Labs: Initial Evaluation
V. Labs: Advanced Testing dictated by History and Exam
- Antinuclear Antibody (ANA)
- Rheumatoid Factor (RF)
- Serum Complement Levels
- Lyme Titer
- Epstein-Barr Virus Testing (Monospot)
- Creatine Phosphokinase (CPK)
VI. Diagnostics: Dictated by History and Exam
- Imaging Studies
- Electromyogram (EMG)