pain

pain

1. history taking

   • physical examination
     • inspection
       • 1) Inspects both shoulder and arms for Symmetry.
         • 2) Inspects the Shape for any boney or joint swellings.
           • 3) Inspects the joint Position
             • 4) Inspects Skin all around the joint for discoloration, scars and abnormal creases.
               • 5) Inspects Muscles all around the joint for atrophy (muscles wasting).
                 • 6) Inspects Bones all around the joint for any deformity.
     • palpation
       • Always you will start the examination with the normal side and during palpation look to the patient’s face.
       • 1. Palpates the Skin for the temperature with the dorsum of your hands simultaneously around the joint from all sides at the same time and compare.
         • 2. Palpates the Muscles for tenderness and atrophy (muscles wasting).
           • 3. Palpates the Joint and Bones surface landmarks
             • 4. Palpates the distal pulse (Radial), comment if it presents or absent.
     • movement
       • active (done by patient)
       • passive (done by the doctor)
   • introduction, consent and privacy

2. causes of pain in the upper limb

   • angina pectoris
     • chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn't get as much blood as it needs. This usually happens because one or more of the heart's arteries is narrowed or blocked
   • brachial plexus injury
     • The brachial plexus is the network of nerves that sends signals from your spinal cord to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.

3. physiology of pain perception

   • pain acts as a signal, alerting us to potential tissue damage, and leads to a wide range of actions to prevent or limit further damage
   • Physiologically, pain occurs when sensory nerve endings called nociceptors (also referred to as pain receptors) come into contact with a painful or noxious stimulus.
     • The resulting nerve impulse travels from the sensory nerve ending to the spinal cord, where the impulse is rapidly shunted to the brain via nerve tracts in the spinal cord and brainstem.
       • The brain processes the pain sensation and quickly responds with a motor response in an attempt to cease the action causing the pain.

4. dermatome of the upper limb

5. shingles

   • caused by the varicella-zoster virus / linear ds DNA / has a latency period
   • is a viral infection that causes a painful rash. It most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso.
   • its clinical presentation
     • Pain / Burning / Numbness and tingling / Crusty fluid-filled blisters / Itching / Fluid filled blisters that break open and crust
   • people at risk
     • old adults / immuno-suppressed (cancer or HIV)
   • Chickenpox is usually a milder illness that affects children. Shingles results from a reactivation of the virus long after the chickenpox illness has disappeared
   • complications
     • The most common complication is long-term nerve pain called postherpetic neuralgia (PHN).
     • Other Complications pneumonia, hearing problems, brain inflammation (encephalitis), or. death

6. management

   • pain killers
     • classes: 1) Non-opioid painkillers (acetaminophen) 2) Anti-inflammatory drugs (NSAIDs) 3) Opioid painkillers (narcotics)
     • Painkillers interfere with pain messages sent to the brain via nerve endings, which affects the brain, spinal cord or injured area. NSAIDs work by blocking the creation of prostaglandins by special enzymes Cox-1 and Cox-2.
     • mechanism of action
       • Some Common NSAIDs Include: Aspirin (irreversibly inactivates COX  by acetylation of a specific serine residue. Whereas all other NSAIDs reversibly inhibit COX) / Diclofenac (Voltaren) / Naproxen / Ibuprofen.
     • side effects of NSAIDs
   • Transcutaneous electric nerve stimulation
     • a therapy that uses low voltage electrical current with the aim to relief pain. One unit consists of a battery-powered device that delivers electrical impulses through electrodes, placed at or near nerves where the pain is located, placed on the surface of the skin
     • relieve both chronic (long lasting) and acute (short-term) pain.

7. psychological effects of pain

   • pain and depression / irritability and frustration / anxiety / stress
     • Nortriptyline is used to treat depression. Nortriptyline is in a group of medications called tricyclic antidepressants. It works by increasing the amounts of certain natural substances in the brain that are needed to maintain mental balance.

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