Chronic Pain

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍month history of chronic pain

Location is on ‍rightleft ‍ ‍generalizedlow back

Onset was ‍gradualsuddentraumatic, started ‍whileafter ‍

Rated at ‍012345678910 / 10 ‍

Impact on daily activities: ‍minimal

Described as ‍crampingburning

Radiation ‍none to ‍

Pattern ‍constantintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍noneactivityrest ‍

Alleviating factors: ‍none ‍ ‍, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍unrefreshing sleep

‍insomnia

‍difficulty

‍difficulty concentrating

‍dizziness

‍muscle pain

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍anxiety

‍depression



Contributing factors:

‍physical trauma

‍emotional trauma

no history of: ‍fibromyalgia, ‍hypothyroidism, ‍anemia, ‍major depressive disorder, ‍lupus





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Metrics: weight: ‍ ‍kglbs, height: ‍ cm, waist: ‍ cm, BMI: ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Cervical spine: ‍tenderness on ‍, range of motion ‍fulllimited

Shoulder: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Elbow: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Wrist: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Hand: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Lumbar spine: ‍tenderness on ‍, range of motion ‍fulllimited

Hip: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Knee: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Ankle: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Foot: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Chronic pain ‍likelysuspectedpossible

DDx: fibromyalgia, neuropathic pain, chronic pain syndrome, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, chronic back pain, chronic neck pain, migraine, tension-type headache, complex regional pain syndrome, temporomandibular joint disorder, cancer-related pain, post-surgical pain, psychogenic pain, depression, anxiety, somatoform disorders, endometriosis, interstitial cystitis, inflammatory bowel disease, pelvic pain syndromes, peripheral vascular disease, HIV-associated neuropathy, diabetic neuropathy, postherpetic neuralgia, substance abuse





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍ESR, ‍creatinine, ‍TSH, ‍calcium, ‍phosphate, ‍albumin, ‍ferritin, ‍vitamin D, ‍uric acid, ‍CK, ‍LFTs

- X-ray of affected areas

- MRI of affected areas

- Nerve conduction studies

- EMG

Treatments:

- Encourage regular exercise

- Heat or cold therapy

- ‍Acetaminophen

- ‍NSAIDs

- ‍Opioids

- ‍Antidepressants

- ‍Anticonvulsants

- ‍Topical Analgesics

- Physical therapy

- Occupational therapy

- Cognitive behavioral therapy

Further care:

- Referral to pain management program

- Referral to pain management specialist

- Referral to rheumatologist

- Referral to physical medicine specialist

- Follow-up in ‍ ‍weeksmonths

- Return if pain worsens, if new symptoms develop such as fever or unexplained weight loss, or if symptoms do not improve with treatment