Page 31 - Learnwell EVS
P. 31
n 1. A few symptomes and syndromes
1
P ain results fro m a variety o f p atho lo gical p ro cesses. It is exp ressed d ifferently by each
p atient d ep end ing o n cultural back gro und , age, etc. I t is a highly subjective exp erience
m eaning th at o nly th e ind ivid ual is able to assess h is/ h er level o f p ain. R egular
assessm ent o f the intensity o f p ain is ind isp ensable in establishing effective treatm ent.
Clinical features
– Pain assessment
• Intensity : use a sim p le verbal scale in child ren o ver 5 y ears and ad ults, and NF C S
o r F L A C C scales in child ren less than 5 y ears (see p ain rating scales o n fo llo wing
p age).
• P attern: sud d en, interm ittent, chro nic; at rest, at night, o n m o vem ent, d uring care
p ro ced ures, etc.
• C haracter: burning, cram p ing, sp asm o d ic, rad iating, etc.
• A ggravating o r relieving facto rs, etc.
– Clinical examination
• O f the o rgan o r area where the p ain is lo cated .
• S p ecific signs o f und erly ing d isease (e.g. bo ne o r o steo articular p ain m ay be caused
by a vitam in C d eficiency ) and review o f all sy stem s.
• A sso ciated signs (fever, weight lo ss, etc.)
– Synthesis
T he sy nthesis o f info rm atio n gathered d uring histo ry tak ing and clinical exam inatio n
allo ws aetio lo gical d iagno sis and o rients treatm ent. I t is im p o rtant to d istinguish:
• Nociceptive p ain: it p resents m o st o ften as acute p ain and th e cause- effect
relatio nship is usually o bvio us (e.g. acute p o st-o p erative p ain, burns, traum a, renal
co lic, etc.) . T he p ain m ay be p resent in d ifferent fo rm s, but neuro lo gical exam is
no rm al. T reatm ent is relatively well stand ard iz ed .
• Neuropathic p ain, d ue to a nerve lesio n (sectio n, stretching, ischaem ia): m o st o ften
ch ro nic p ain. O n a back gro und o f co nstant, m o re o r less lo caliz ed p ain, such as
p araesthesia o r burning, there are recurrent acute attack s such as electric sho ck -lik e
p ain, frequently asso ciated w ith d iso rd ered sensatio n ( anaesth esia, h y p o o r
hy p eraesthesia). T his ty p e o f p ain is link ed to viral infectio ns d irectly affecting the
C NS ( h erp es sim p lex, h erp es z o ster) , neural co m p ressio n by tum o rs, p o st-
am p utatio n p ain, p arap legia, etc.
• Mixed p ain (cancer, H IV ) fo r which m anagem ent requires a bro ad er ap p ro ach.
29
1
P ain results fro m a variety o f p atho lo gical p ro cesses. It is exp ressed d ifferently by each
p atient d ep end ing o n cultural back gro und , age, etc. I t is a highly subjective exp erience
m eaning th at o nly th e ind ivid ual is able to assess h is/ h er level o f p ain. R egular
assessm ent o f the intensity o f p ain is ind isp ensable in establishing effective treatm ent.
Clinical features
– Pain assessment
• Intensity : use a sim p le verbal scale in child ren o ver 5 y ears and ad ults, and NF C S
o r F L A C C scales in child ren less than 5 y ears (see p ain rating scales o n fo llo wing
p age).
• P attern: sud d en, interm ittent, chro nic; at rest, at night, o n m o vem ent, d uring care
p ro ced ures, etc.
• C haracter: burning, cram p ing, sp asm o d ic, rad iating, etc.
• A ggravating o r relieving facto rs, etc.
– Clinical examination
• O f the o rgan o r area where the p ain is lo cated .
• S p ecific signs o f und erly ing d isease (e.g. bo ne o r o steo articular p ain m ay be caused
by a vitam in C d eficiency ) and review o f all sy stem s.
• A sso ciated signs (fever, weight lo ss, etc.)
– Synthesis
T he sy nthesis o f info rm atio n gathered d uring histo ry tak ing and clinical exam inatio n
allo ws aetio lo gical d iagno sis and o rients treatm ent. I t is im p o rtant to d istinguish:
• Nociceptive p ain: it p resents m o st o ften as acute p ain and th e cause- effect
relatio nship is usually o bvio us (e.g. acute p o st-o p erative p ain, burns, traum a, renal
co lic, etc.) . T he p ain m ay be p resent in d ifferent fo rm s, but neuro lo gical exam is
no rm al. T reatm ent is relatively well stand ard iz ed .
• Neuropathic p ain, d ue to a nerve lesio n (sectio n, stretching, ischaem ia): m o st o ften
ch ro nic p ain. O n a back gro und o f co nstant, m o re o r less lo caliz ed p ain, such as
p araesthesia o r burning, there are recurrent acute attack s such as electric sho ck -lik e
p ain, frequently asso ciated w ith d iso rd ered sensatio n ( anaesth esia, h y p o o r
hy p eraesthesia). T his ty p e o f p ain is link ed to viral infectio ns d irectly affecting the
C NS ( h erp es sim p lex, h erp es z o ster) , neural co m p ressio n by tum o rs, p o st-
am p utatio n p ain, p arap legia, etc.
• Mixed p ain (cancer, H IV ) fo r which m anagem ent requires a bro ad er ap p ro ach.
29
