Subjective Exam – Classifying Nociceptive/Mechanical Pain
The framework I classify patients with Mechanical/Nociceptive pain under is based on the following flow chart taught to me in my postgraduate degree.
The first thing to note is that this classification process begins in the subjective exam. It does not end after it. The left side of the chart refers to chemical pain i.e. Inflammatory pain. Whilst the right side refers to Mechanical/Nociceptive pain.
As mentioned in the last post:
“A patient with pure Nociceptive pain will present with clear mechanical signs. That is they will report movements and or postures that cause their pain. Avoidance of these aggravating activities and/or rest will cause no symptoms. If you recall from the previous post this is referred to as stimulus evoked pain i.e. pure nociceptive pain should be intermittent in nature”.
In the subjective one of the key elements we can ask someone with mechanical/nociceptive pain is what aggravates their pain. Insightful questioning can tell us if their key aggravating factors are related to loading (sustained posture or position), movement or both. Whilst the objective will confirm this, and assist us in assessing components to assist the above flow chart process, we can begin to get a picture/story of what the patient has trouble doing.
Importantly if we can identify the aggravating factors we can then ensure we assess some/all of these in the objective exam and ascertain if there is a movement impairment or control impairment.
I think the best way to further explain how we do this is to utilise case examples. These will soon start but I want to talk through some journal articles relating to movement impairments vs control impairments.
About the Author: Mark Gibson
Mark is a Specialist Musculoskeletal Physiotherapist who consults at both Insight Physiotherapy and Pain Options, in Perth, Western Australia. He specialises in the assessment and management of persistent/chronic musculoskeletal pain. In addition to his clinical role he maintains regular involvement in education of the profession having held a Teaching Fellow position at the University of Western Australia for 10 years and regularly presenting at courses and seminars through the Australian Physiotherapy Association and private education sector. Mark is also a Facilitator for the Australian College of Physiotherapists Specialisation Training Program and a Sessional Academic at Curtin University. The views expressed on this blog are his own.Subscribe
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