Clinical Reasoning
Sleep and Chronic Pain
I think most of us ask our patients about their quality of sleep. My previous experience in relation to asking this was purely to assist in identifying: Inflammatory pain patterns (as mentioned in a previous post). Potential “Red Flag” signs. The more I read about sleep it becomes apparent to me the need to take […]
The Biopsychosocial Model
Sorry for the delay in posts. Winter has not been kind for illness! For those not familiar with the Biopsychosocial model I would recommend that you read the following article in relation to the to biopsychosocial model. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and […]
Case Example 1 – Lumbar Pain
Sorry for the delay in this post……… Looking forward to feedback/thoughts regarding this patient, and the layout of the case report. Enjoy. Key Subjective Findings: 26 year old male. Original Lumbar Injury in November 2011 whilst lifting a piece of concrete (approx. 20kg) from the floor. Received a week of physiotherapy management. Outcome being full […]
Objective Exam – Framework
This is the framework I use for my objective assessment. This is a work in progress…..so I don’t think that this is perfect and I certainly cannot ideally implement it exactly yet. I am not going to talk about diagnostic/orthopaedic tests. They have their place in an exam, and certainly providing a specific structural diagnosis, […]
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. […]
Clinical Reasoning – Identifying Types of Pain
I think one of the key aspects of our clinical reasoning process is in the identification of the types of pain. Our subjective examination can play significant role in identifying pain type(s). As posted previously Woolf (2004 and 2010) and Costigan et al (2009) divide pain into the following types: Nociceptive Inflammatory Pathological – subdivided into Neuropathic […]
Central Sensitisation
I briefly discussed Central Sensitisation (CS) in a previous post on pain. CS has, at times, been a confusing topic. As mentioned in my last post on pain, based on my readings, CS is not a type of pain, it is a mechanism relating to pain. Understanding the mechanism is helpful in understanding the symptoms. […]
Stimulus-Dependent and Spontaneous Pain
I think that one of the key things we should look for in the patient assessment is the behaviour of pain. Is the pain Stimulus-dependent and/or Spontaneous pain. The “evoking” of pain can be an important aspect to ascertain in the subjective and objective examination. The diagrams at the end of this post (from Costigan […]
Types of Pain
Before writing about my framework for my subjective I think it is important to summarise pain. Recent reflection on my clinical knowledge of pain made me realise how poor my knowledge was. I have since realised the importance, from a diagnosis, management and prognosis aspect, of being able to identify what pain(s) are contributing to […]
My Clinical Approach
I recall not long after starting the Specialisation Training Program that a Specialist Colleague of mine mentioned one of the key processes to have in place was a sound conceptual framework that your assessment and management is based on. My framework is based on what I have been taught, my clinical experience and other clinicians […]
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