CLINICAL FEATURES AND INVESTIGATIONS

Types of Pain

There are 2 types of pain that health workers need to be aware of:

TYPE OF PAIN FEATURES

Nociceptive Pain

The pain pathways are
intact. This kind of pain
responds to the analgesic
ladder
  • Somatic Pain (from
    bones and muscles):
    described as aching/
    throbbing
  • Visceral Pain: described
    as colicky pain (for
    hollow viscera), pressure,
    cramping and ache for
    solid viscera

Neuropathic Pain

There is damage to nerves
or the pathways. The pain
responds only partially
to the analgesic ladder
and needs adjuvants
of amitriptyline or
phenytoin
  • Described as burning,
    prickling, stinging,
    pins and needles,
    insects crawling
    under skin, numbness,
    hypersensitivity,
    shooting, or electric shock

Clinical investigation

It is important for health workers to conduct a thorough investigation of a patient indicating they are in pain. The
following points can be used to guide the investigation:

  • Duration of pain
  • Severity: assess using the Numerical Rating Scale, where the patient grades his/her pain on a scale of 0 = no pain to 5 = worst pain ever experienced
  • Site and radiation
  • Nature (e.g., stabbing, throbbing, crushing, cramp-like)
  • Periodicity (constant or intermittent)
  • Relieving or aggravating factors
  • Accompanying symptoms
  • Ask the patient for a detailed history for each pain experienced, as there may be more than one type of pain
    and area experiencing pain
  • A targeted physical examination