Diagnosis


 * __Diagnosis __**
 * Pain is difficult to diagnose due to the high degree of subjectivity.
 * Each person will experience pain differently and no-one has the exact pain threshold as another person, which makes pain very difficult to diagnose.
 * There are 5 characteristics of pain PQRST. However from my research I have found that many institutions expand on Provocation and include Onset as well as separating Region and Radiation.
 * Onset of the event
 * What the patient was doing when it started (active, inactive, stressed)
 * Whether the patient believes that activity prompted the pain
 * Whether the onset was sudden, gradual or part of an ongoing chronic problem.
 * Provocation
 * Whether any movement, pressure (such as palpation) or other external factor makes the problem better or worse. This can also include whether the symptoms relieve with rest.
 * Quality of the pain
 * Must be the patient's description of the pain.
 * Questions can be open ended ("Can you describe it for me?") or leading.
 * Is it sharp, dull, crushing, burning, tearing, or some other feeling
 * The pattern, such as intermittent, constant, or throbbing.
 * Region and Radiation
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Where the pain is on the body
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Does it radiate (extends) or moves to any other area. This can give indications for conditions such as a myocardial infarction, which can radiate through the jaw and arms. Other referred pains can provide clues to underlying medical causes.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Patients with chronic or visceral pain might have difficulty localizing specific area.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Severity - show sliding scale.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Since pain is subjective, it is very important to have patients rate the pain they are experiencing. This becomes extremely important when assessing the effectiveness of pain medications.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The pain score (usually on a scale of 0 to 10). Zero is no pain and ten is the worst possible pain. This can be comparative (such as "... compared to the worst pain you have ever experienced") or imaginative ("... compared to having your arm ripped off by a bear").
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The nurse needs to assess the patients verbalisations of their pain, whether the score given is realistic within their experience - for instance, a pain score 10 for a stubbed toe is likely to be exaggerated.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">This may also be assessed for pain now, compared to pain at time of onset, or pain on movement.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Does the pain change with medication?
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">There are alternative assessment methods for pain, which can be used where a patient is unable to vocalise a score. One such method is the Wong-Baker faces pain scale, which is quite simplified – used with children and people whose 1st language was not English.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">More in-depth model.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Time (history)
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">How long the condition has been going on?
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">How it has changed since onset (better, worse, different symptoms)?
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Is it intermittent?
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Whether it has ever happened before, changes?
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">When the pain stopped if it is no longer currently being felt.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Are there any Associated Phenomena?
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Identify if there were any factors that seem to relate consistently to the pain. Examples - Increased anxiety before pain begins
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">b. Physiological responses
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Sympathetic stimulation – occur with acute pain
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Parasympathetic stimulation - with prolonged severe pain
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Responses to watch - Vital signs, skin colour, perspiration, pupil size, nausea, muscle tension, anxiety
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Behavioural Responses
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Posture, gross motor activities - Assess if the patient guards an area
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Does the patient make frequent position changes?
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Posture and gross motor activities increased in acute pain, might be absent with chronic pain

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">DERMATOMES


 * ** Dermatomes **


 * The surface of the skin is divided into specific areas called dermatomes, which are derived from sensory neurons.
 * Dermatomes can be associated with the body’s sensory nerves (the sense of touch) or the motor nerves (the ability to move).
 * These cells differentiate into the following 3 regions:
 * myotome, which forms some of the skeletal muscle;
 * dermatome, which forms the connective tissues, including the dermis;
 * sclerotome, which gives rise to the vertebrae.
 * A dermatome is an area of skin in which sensory nerves derive from a single spinal nerve root.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">These level designations also apply to spinal nerves as they branch off the spinal cord.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Nerve roots branch off the spinal cord and travel through openings in the vertebrae called foramina. There are a two nerve roots that branch off at each vertebral level – one on each side of the vertebra. Eventually, the nerve roots branch out further and further, creating a network of nerves throughout the body.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">IMAGE
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Dermatomes sometimes can be used to isolate problems in the spinal cord because pain on or around a specific dermatome can be traced back to a specific nerve root that is damaged, trapped, or constricted. Dermatome pain mapping also can help to isolate viruses that are infecting the spinal nerves, such as shingles. When dermatome pain, numbness, tingling, or weakness is identified, a Doctor will most likely palpate the corresponding area of the spine to try and identify the specific damaged nerve root.


 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Trigeminal Nerves
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">V1 - Ophthalmic Division of Trigeminal Nerve (Upper Face
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">V2 - Maxillary Division of Trigeminal Nerve (Mid Face)
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">V3 - Mandibular Division of Trigeminal Nerve (Lower Face
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Cervical (C2-C7) fingers neck funny bone and scalp
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Thoracic (T-1 through T-12) contain nerves corresponding to the nipples, chest, belly button area, pubic bone, and lower sternum.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Through L-5) contain nerves corresponding to the hips, the front of the legs, the shins, knee caps, and most of the feet.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Sacral (S-1 through S-5) contain nerves corresponding to the genitals, buttocks, back of the legs, and calves


 * ** Tests **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The traditional tests used to diagnose painful conditions include X-rays, magnetic resonance imaging (MRI), electromyography (EMG), and nerve conduction studies. But the first option is usually an Ultrasound.
 * ** CT or CAT scan: **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Use X-rays and computers to produce an image of a cross-section of the body.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">During the test, the patient will be asked to lie as still as possible on a table. The table will move through a large, donut-shaped scanning device. Sometimes, intravenous contrast material is required for a CAT scan.
 * <span style="color: #363534; font-family: 'Times New Roman','serif'; font-size: 16px;">Psychological Involvement
 * <span style="color: #363534; font-family: 'Times New Roman','serif'; font-size: 16px;">Many of the pain questionnaires that are used to assist in the diagnosis of chronic pain attempt to determine the impact of this pain on the workplace, home, social interaction, and physical activity. These questionnaires are taken together with the normal history and physical exam in making a diagnosis of chronic pain.
 * <span style="color: #222222; font-family: 'Times New Roman','serif'; font-size: 16px;">Pain is intimately tied to brain functions that govern behavior and decision making, including expectation, attention and learning.
 * <span style="color: #363534; font-family: 'Times New Roman','serif'; font-size: 16px;">Depression resulting from severe, chronic pain is the most common psychological problem in pain patients.
 * **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Ultrasound **imaging:
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Sonography uses high-frequency sound waves to obtain images inside the body. The sound wave echoes are recorded and displayed as a real-time visual image.
 * ** MRI: **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Magnetic resonance imaging produces very clear pictures of the body without the use of X-rays.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">This test uses a large magnet, radio waves and a computer to produce images. Certain MRI exams require an injection of a contrast material called gadolinium, which helps identify certain anatomic structures on the scan images.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Due to the magnets used in the study, some people (like those who have pacemakers) should not have an MRI.
 * ** Discography: **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">A contrast dye is injected into the spinal disc that is thought to be causing back pain. The dye outlines the damaged areas on X-rays taken following injection.
 * ** Myelograms: **<span style="font-family: 'Times New Roman','serif'; font-size: 16px;"> As in discography, during the myelogramprocedure, a contrast dye will be injected into the spinal canal to enhance the diagnostic ability of X-ray.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Doctors are able to see on X-ray the image of the spinal cord and can identify nerve compression caused by herniated discs or fractures.
 * ** EMG: **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Evaluate the activity of the muscles. During the procedure, very fine needles are inserted in muscles to measure the muscles response to signals from the brain or spinal cord.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Blocking these structures with a local anaesthetic can help to distinguish between pain that might be arising within a nerve or nerves, or from the structures that they serve. Such tests might involve the sequential blocking of a peripheral nerve, the nerve root from which it arises, or a structure within the spinal canal, for example.
 * ** Bone scans: **
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Diagnose and monitor infection, fracture, or other disorders in the bone.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">A small amount of radioactive material is injected into the bloodstream. The material will collect in the bones, particularly in areas with any abnormality.
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Scanner-generated images identify specific areas of irregular bone metabolism or abnormal blood flow.