Pain
Classification of Central Sensitisation, Nociceptive Pain and Peripheral Neuropathic Pain
Keith Smart and colleagues have published a number of articles, over the past year or two, in relation to classification of Central Sensitisation, Nociceptive Pain and Peripheral Neuropathic Pain. I think their findings are very useful in the clinical setting to guide us in our decision making. Recent articles ,published in Manual Therapy in 2012, identified […]
Classification of Radiculopathy and Peripheral Neuropathic Pain
Now before we start I want to state that most of my knowledge regarding this topic has developed from attending lectures/courses/practical sessions with Dr Toby Hall (Specialist Musculoskeletal Physiotherapist). I would encourage anyone reading this post to take any opportunity that arises to attend a course of Toby’s. He is a wealth of knowledge and […]
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 […]
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