Rheumatology Book


Chronic Pain Evaluation

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

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