history taking in pain medicine is most imp part,in this covered all the imp aspects refrence:The art of history taking in patient with pain:An ignored but very important component
in making diagnosis;Indian Journal of Pain | May-August 2013 | Vol 27 | Issue 2
definition of pain - classification - categories and different clinical types of pain - assessment of pain and how to manage using pharmacological and non-pharmacological intervention
definition of pain - classification - categories and different clinical types of pain - assessment of pain and how to manage using pharmacological and non-pharmacological intervention
Pain History Taking in Physical TherapyAzkaSamreen
The art of history taking in patients with pain is an ignored but very important component in making diagnosis. In this tutorial we take you through a basic structure for taking history from someone presenting with pain.
Introduction to musculoskeletal physical therapy principles and concepts.
MSK physical therapy is a speciality of pt. that deals with diagnosis, management and treatment of disorders and injuries of the musculoskeletal system including:
Rehabilitation after orthopedic surgery
Acute trauma such as sprains, strains
Injuries of insidious onset such as tendinopathy and bursitis.
This speciality of physical therapy is most often found in the out-patient clinical setting.
Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions, and amputations.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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1. History taking in pain medicine
Dr Minhaj Akhter
Post-Doctoral Fellowship SR
Pain and Palliative Care
Department of Anaesthesiology and Critical Care
AIIMS, Jodhpur
2. • Sufficient time
• Careful listening
• Empathy
• Trust development
• How and when to interfere
• Effect of pain
• Special attention
3. • CHIEF COMPLAINT
• HOPI
• TREATMENT HISTORY
• FAMILY HISTORY
• PERSONAL HISTORY
• OCCUPATIONAL HISTORY
• PSCHYLOGICAL ASSESMENT
1.Quantity or severity and intensity of
pain.
a) Unidimensional pain scale
b) Multidimensional pain
scale
2. Quality or nature of pain.
3. Mode of onset and location.
4. Duration and chronicity, frequency
5.Provocative and relieving factors.
6. Special character.
7. Timing of pain, diurnal variation
8. In relation to posture.
9. Site of pain and radiation of pain
10. Associated complaints
4. Chief complaint
• Pain at different location with duration
• Complaint may be one or more
• Write in chronological order
5. history of present illness
(1) Quantity or severity and intensity of
pain
a) Unidimensional pain scale
b) Multidimensional pain scale
• Pain should be assessed upon movement, not just like that
when the patient is lying still to minimize discomfort
7. VERBAL RATING SCALES (VRS)
• Pain is described as none, mild, moderate, or severe
• This scale is short, easy to administer, and understand
especially in elderly patients
8. THE BINARY SCALE
• Patient is asked to answer for the question like — is your pain
60% relieved? “Yes or No.”
• Short, easy to administer, and easy to understand
9. THE NUMERICAL RATING SCALE (NRS)
• Most commonly used
• Two extremes of the pain experience is noted and has a
numerical scale between “no pain” and “worst pain
imaginable.”
• “Zero” corresponds to no pain and “10” corresponds to the
worst pain imaginable
• Advantage- easy to understand, Disadvantage - digital scale
• A reduction of 30% or 2 points and more from baseline in
patient on treatment indicates positive response for treatment
10. THE FACES RATING SCALE
• Patient is asked to point to various facial expressions ranging
from a smiling face (no pain) to an extremely unhappy one
(the worst possible pain)
• It can be used in patients with whom communication may be
difficult
11. THE VISUAL ANALOG SCALE (VAS)
• Similar to the numerical rating scale
• There is a 10-cm horizontal line labeled “no pain” at one end
and “worst pain imaginable” on the other end
• Patient is asked to mark on this line where the intensity of the
pain lies, distance from “no pain” to the patient’s mark
numerically indicates the severity of the pain
• The VAS is a simple, efficient, valid, and minimally intrusive
method
• The disadvantage is it is more time consuming than other
instruments
13. THE MCGILL PAIN QUESTIONNAIRE…
• Words in each class are given rank according to severity of
pain
• Translated to multiple languages
• Advantage- Reliable, completed in 5-15 min, it helps in the
diagnosis as the choice of descriptive words that characterize
the pain correlates well with pain syndromes
• Disadvantage-High levels of anxiety and psychological
disturbance can obscure the MPQ’s discriminative capacity
14. THE MCGILL PAIN QUESTIONNAIRE (MPQ)
• Developed by Melzack and
Torgerson
• Define the pain in three major
dimensions by 20 sets of
descriptive words divided as
follows:
a. Ten sets describe sensory-discriminative
(nociceptive pathway)
b. Five sets describe motivational-affective
(reticular and limbic structures).
c. One set describes cognitive- evaluative
(cerebral cortex).
d. Four sets describe miscellaneous
dimensions.
15. • BRIEF PAIN
INVENTORY (BPI):
• It measures both the intensity
of pain (sensory dimension)
and the interference of pain
in the patient’s life (reactive
dimension)
• Translated to multiple
languages
• Advantages: It is a reliable
and valid for the cancer pain
and many pain syndromes
and can be completed in 5-15
min
• It shows good sensitivity to
treatment effects (mostly in
pharmacological treatments)
16. • WEST HAVEN-YALE MULTI-
DIMENSIONAL PAIN INVENTORY
(WHYMPI):
• Composed of 56 items with three parts
• Five dimensions covering the experience of pain and
suffering, interference with family, social and work functions
• Patients respond to the questions on a 7-point scale
• Advantages- Valid in many pain syndromes, good sensitivity
to treatment effects
17. MEDICAL OUTCOME STUDY 36-ITEM
SHORT-FORM HEALTH SURVEY (SF-36)
It consists of eight subscales
including
1. Physical functioning
2. Limitations due to physical
problems
3. Social functioning
4. Bodily pain
5. Role limitations due to
emotional problems
6. General mental health
7. Vitality
8. General health perceptions
Advantages:
a) It is the most widely used
instrument to measure
multiple dimensions of
quality of life
b) It is used in almost every
diseases or conditions
imaginable
c) It is easy to administer,
taking about 10 min to
complete
18. (2)Assessment of Quality or Nature of
Pain
• Nature or character of pain whether it is nociceptive or
neuropathic or a mixed variety or nociplastic
• There are different validated questionnaire-based tools, which
helps us in identifying neuropathic pain conditions
• Nociceptive pain is easy to manage
• Neuropathic pain can lead to catastrophic stage if not
diagnosed and treat properly
19. • Neuropathic pain has been defined by the Special Interest
Group on Neuropathic Pain (NeuPSIG) as
“pain arising as a direct consequence of a lesion or disease
affecting the somatosensory system.”
• Associated with suffering, depression, anxiety, disturbed sleep,
and impaired quality of life
21. LEEDS ASSESSMENT OF NEUROPATHIC
SYMPTOMS AND SIGNS (LANSS) (2001)
• First screening test to identify pain of neuropathic origin
• Five symptoms, two signs- addressing pain quality and
triggers
• Each item is a binary response (yes or no)
• Sensitivity - 82% to 91% , Specificity- 80% to 94%
• Score < 12/24 - Pain is unlikely to be neuropathic in origin
Score ≥ 12/24 - Pain is likely to be neuropathic in origin
• The need for clinical examination and pin prick testing limits
its use in clinical setting.
23. NEUROPATHIC PAIN QUESTIONNAIRE (NPQ)
• It is a self-questionnaire consisting of 12 items: 10 related to
sensations and two related to affect
• Each item is scored on a scale of 0 (no pain) to 100 (worst
possible pain)
• Sensitivity 66%, Specificity 75%
24. DOULEUR NEUROPATHIQUE EN 4
QUESTIONS (DN4)
• Seven items related to symptoms ,Three items related to
physical examination
• Each item is scored 1 (yes) or 0 (no)
• Score of ≥4 as neuropathic pain
• Sensitivity 83%, Specificity 90%
25. PAIN DETECT
• Simple, Patient-based self-report questionnaire
• consisting of nine items: seven sensory descriptors and
two related to spatial (radiating) and temporal
characteristics
• Sensory descriptors are scored on a scale of 0 (no) to 5
(very strongly) and radiating pain as 1 (yes) or 0 (no)
• Score of ≥19 indicate neuropathic pain likely and ≤12
neuropathic pain unlikely
• Sensitivity 85% , Specificity of 80%
26.
27.
28.
29.
30. ID-PAIN
• Self-questionnaire consisting of five sensory descriptors and
one item regarding pain located in the joints (to identify
nociceptive pain)
• Does not require a clinical examination
• Scoring is from 1 to 5 with higher score indicating neuropathic
pain
31. (3)Mode of Onset and Location
• Important for the etiology of pain
• Onset may be sudden or gradual
• Sudden onset of severe pain without any provocation e.g.
severe intolerable headache may be due to subarachnoid
hemorrhage
• Sudden severe pain on patients with pre-existing pain e.g.
severe back pain in elderly patients with pre-existing back pain
may be due to spinal carcinoma metastases
32. (3)Mode of Onset and Location…
• Site of onset gives better idea in finding out primary reason
• Lumbar facet joint arthropathy patient gives history of pain on
lower back, buttock, and thigh but on enquiry they will show
onset on paramedial region and later distributed to other
regions
• It is not uncommon for patient to link pain to trauma in the
past or present, which may not be relevant
• Detailed enquiry may reveal pain-free period after trauma
33. (4)Chronicity (Duration and Frequency)
• Plays a vital role in the diagnosis e.g. Migraine, unilateral pain
is frequently throbbing and may last for hours to days
• Patient with long history of pain, physical provocative test may
become negative
• In this case, history of pain in leg with neuropathic character,
exaggerated on exertion and relieved by rest may be only clue
for its diagnosis
• In chronic pain conditions, sympathetic system (central
sensitization) main pain mediator
• Explain diffuse the nature of pain in patient and failure to
respond to conventional (interventional) treatment
34. (5)Provocative and relieving factor
• Provide valuable clues to the diagnosis
• Leg and back pain due to spinal stenosis worsening with
walking or standing and relieved with sitting or lying down
• Lower lumbar facet and sacroiliac joint may have similar
history sitting relieve pain in facet joint syndrome not in
sacroiliac joint arthropathy in which sitting may provoke pain
35. (6)Special Character
• Special character can clue in diagnosis
• In cluster headache the pain usually deep, boring, wrenching,
while vascular headache it is throbbing, pulsatile, and severe in
intensity
• Idiopathic trigeminal neuralgia pain tends to be unilateral,
paroxysmal, sharp, shooting, and lancinating along one or
more branches of trigeminal nerve, whereas the pain of
temporomandibular joint dysfunction tends to be unilateral,
dull aching, and around the affected joint
• Postherpetic neuralgia pain may be burning and aching
associated with dysesthesias, and allodynia
36. (7)Timing of Pain and diurnal variation
• Pain and stiff ness felt in the morning hours persisting for
more than hours may be inflammatory arthropathy
• Pain after any inactivity persisting less than half an hour or
after prolonged activity goes more in favor of degenerative
arthropathy
• Severe headache occurring regularly at a particular time,
particular season may give clue for cluster headache
• Neuropathic pain can be more severe in the night
37. (8)Relation with Posture
• Pain increase on sitting on floor in sacroiliac(SI) joint
arthropathy
• Cross-legged sitting painful in piriformis syndrome, IT band
syndrome, AVN hip, Hip adductors strain
• Pain on change of posture such as turning in bed, standing
from sitting position goes more in favor facet joint syndrome
• Prolonged sitting produces more pain in discogenic pain
• Patients with spinal canal stenosis have more pain on standing
and walking
39. (10) Associated Complaints
• Weakness, numbness may indicate neurologic deficits.
• Weakness may also be present muscular injury
• Fever may indicate infections
• Nausea/vomiting have diagnostic value in migraine, space
occupying lesion of brain etc
40. Past History
• Any pain events mimicking present, ask for progress,
diagnosis, and any treatment taken and procedure/operation
done
• History of rash, vesicles in the same dermatome as of present
neuropathic pain can confirm post-herpetic neuralgia
• Some diseases have periodic occurrence and they can have
multiple same type of previous episodes before presenting to us
at present e.g. cluster headache
41. Past History…
• Patient with multiple episodes of pain can have associated
significant cognitive disturbance
• Patient can have some disease, which can influence the
manifestation of pain (e.g, dementia) or it can interfere with
treatment (organ damage)
• History targeted on finding etiology of pain can help in finding
other pain manifestations of a disease (eg, multiple sclerosis).
• Diabetes, hypertension, thyroid disorder, dementia,
parkinsonism, liver and kidney compromise, inflammatory
disorders should be given more importance on its presence
42. Personal History Including Sleep, Bladder/Bowel Habit
• Patient with pain can have some psychological disorders, such
as anxiety and depression, which occurs primarily because of
pain, leads to patient’s less tolerance to pain and decreased
coping capacity
• e.g. Dementia, bipolar disorder, Post Traumatic Stress
Disorder (PTSD) and Attention Deficit Hyperactivity Disorder
(ADHD)
43. • A lot of tools are available for mental status assessment, which
includes
PHQ-9
Beck Depression Inventory
Hamilton Depression Scale
Zung Self-Rating Depression Score
Hospital Anxiety and Depression Scale (HADS)
Pain Catastrophizing Scale (PCS)
The Tampa Scale of Kinesophobia
44. PHQ-9
• Maximum score is 27
• Score 1-4/27 indicates
minimal depression
• 5-9/27 indicates mild
depression
• 10-14/27 indicate
moderate depression
• 15-19/27 indicate
moderately severe
depression
• 20-27/27 indicate
severe depression
45. BECK DEPRESSION INVENTORY
• This have 21 parameters and each are graded from 0 to 3 thus
have total score of 63
• Result will be inferred as below
1-10 — Ups and downs are considered normal.
11-16 — Mild mood disturbance.
17-20 — Borderline clinical depression.
21-30 — Moderate depression.
31-40 — Severe depression.
>40-Extreme depression.
46. HAMILTON DEPRESSION SCALE
• It includes 17 parameters with score grade of 4 items
(symptom is absent, mild, moderate, severe and very severe), 2
items (symptom is absent, mild and defi nite)
• Total score of 0-7, 8-13, 14-18, 19-22, ≥ 23 indicates normal,
mild, moderate, severe and very severe depression
accordingly.
47. • Sleep disorder and pain is highly inter linked together, sleep
disorder in over 70% of patient
• Pain may be interrupted e.g. posttraumatic stress disorder
• Patient can feel inadequate sleep on waking up e.g. fibromyalgia
• Effective treatment of sleep disturbance will involve assessing and
treating all of the contributing factors
• Chance of pregnancy should be ruled out in women of child-bearing
age
• Bladder and bowel disturbance may be an associated component or
etiology for present pain complaint e.g. history of inflammatory
bowel disease may be a reason for seronegative inflammatory
arthropathy, and irritable bowel disease may be an associated
disease of fibromyalgia
Personal History…
48. Treatment History
• Initial questionnaire should allow the patient to list all the
therapeutic modalities they are currently using or have used in
the past
• Chances of drug addiction should be ruled out before
prescribing any drugs
• Any drug allergy, any side effect/complication to past
treatment or comorbid condition (renal, hepatic compromise)
should be taken into consideration before prescribing medicine
49. Family History
• History of pain and diseases in family members can support in
getting diagnosis as some diseases run among families e.g.
Rheumatoid arthritis, Fibromyalgia etc.
• History of family dispute should be ruled out in patients
having disproportionate, irrelevant, and unusual manifestations
50. Occupational history
• LOW BACK PAIN
• NECK PAIN
• SHOULDER PAIN
• ELBOW (LATERAL AND MEDIAL EPICONDYLITIS)
• TRIGGER FINGER
• DE QUERVAIN'S TENOSYNOVITIS
• CTS
• PRONATOR SYNDROME
• THORACIC OUTLET SYNDROME
51. Understanding or Warning Signals
• We must be very cautious in dealing certain painful conditions, which can
be potentially dangerous
• We must be having multidisciplinary approach to deal with these patients
I. Pain with major trauma
II. Suspecting tumor
III. Suspecting infection with fever, rigor, vomiting, and so on
IV. Unconsciousness
V. Motor weakness
VI. Progressive sensory deficit
VII. Loss of vision
VIII. Loss of bladder control with retention and incontinence
IX. Loss of bowel control with inability to force to pass stool
X. Sudden onset pain, which is progressing rapidly
XI. Not relieved by analgesic within few days