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Inquiry into pain
- 1. PAIN "I don't accept the maxim 'there's no gain without pain', physical or emotional. I believe it is possible to develop and grow with joy rather than grief. However, when the pain comes my way, I try to get the most growth out of it." Alexa McLaughlin MAJOR ARSHAD HAYAT MCPS FCPS DEPT OF CRITICAL CARE MEDICINE MH
- 2. The International Association for the Study of Pain defines pain as: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" DEFINITION
- 3. HISTORY Derived from Latin -“Poena” meaning punishment from God. Homer thought pain was due to arrows shot by God. Aristotle, who probably was the first to distinguish five physical senses considered pain to the “passion of the soul” that somehow resulted from the intensification of other sensory experience.
- 4. Plato contented, pain and pleasure arose from within the body, an idea that perhaps gave birth to the concept that pain is an emotional experience more than a localized body disturbance. The Bible makes reference to pain not only in relationship to injury and illness but also an anguish of the soul.
- 5. ‘SOCRATES’ is a mnemonic acronym used by emergency medical services, doctors, nurses and other health professionals to evaluate the nature of pain that a patient is experiencing. The acronym is used to gain an insight into the patient's condition, and to allow the Health Care Provider to develop a plan for dealing with it. INQUIRY INTO PAIN
- 6. Site - Where is the pain? Or the maximal site of the pain. Onset - When did the pain start, and was it sudden or gradual? Include also whether if it is progressive or regressive. Character - What is the pain like? An ache? Stabbing? Radiation - Does the pain radiate anywhere? WHAT DOES THE ACRONYM STAND FOR?
- 7. Associations - Any other signs or symptoms associated with the pain? Time course - Does the pain follow any pattern? Exacerbating/Relieving factors - Does anything change the pain? Severity - How bad is the pain?
- 8. 1. SITE Central chest pain Peripheral chest pain Epigastrium Right hypochondria Left hypochondria Periumblical Lumbar areas Suprapubic Right iliac fossa Left iliac fossa
- 9. 2. ONSET OF PAIN THUNDERCLAP OVER MINUTES OVER HOURS DAYS
- 10. 3. CHARACTER OF PAIN SHARP WELL LOCALIZED PAIN: DULL BORING PAIN BURNING PAIN PLEURITIC COLIC / CRAMPING PAIN DISTENDING PAIN STABBING/ PRICKING PAIN SHOOTING / LANCINATING PAIN
- 11. 4. RADIATION OF PAIN 1. Retrosternal pain radiating to the left arm/neck/ right arm 2. Epigastric pain radiating to the back 3. Right hypochondria pain radiating to the right shoulder 4. Loin to groin pain 5. Back pain radiating down the leg 6. Neck pain radiating down the arms
- 12. 5. ASSOCIATIONS Pain of acute MI Peptic ulcer Pneumonia S.A.H Acute Cholecystitis Renal colic Intestinal obstruction Migraine Glaucoma
- 13. 6. TIME/COURSE Worsening/aggravating over time? No change, Decreasing over time Any specific time? Nocturnal? After meals? Fatty meals? Early morning headaches? Backache while lying supine at night?
- 14. 7. AGGRAVATING/RELIEVING FACTORS Pain of MI Pleuritic pain SOL Brain Migraine APD Angina Cholecystitis pericarditis
- 15. 8. SEVERITY Mild , moderate , severe Scale of 1-10
- 16. THANKYOU