Physical Examination in Pain Medicine

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I can't believe we are debating the utility of physical examination in pain management patients... We don't believe in most things the patient says but suddenly their honest-to-god history is replacing a physical examination. Probably makes it easier to skew the entire evaluation based on what diagnosis you are projecting or what you were cued to diagnose by the patient. Who wants to think too much anyway.

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With most working aged CNP patients I'd argue that the history - including a pain diagram, work Hx, litigation Hx, catastrophizing score, ROS, imaging, and PDMP run- is worth a hell of a lot more than the exam.

What's abnormal on an exam for LBP, HA, or FMS? If I had to pick between my intake questionnaire/Imaging/PDMP vs Exam in the CNP audience, I'd pick the former every time.
 
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Totally agree with above, but in fellowship, you better damn well learn and do appropriate focused physical exams. Thats a given.




Yea, I agree. Imagine you send a chronic pain patient with mood issues to a local therapist. The patient comes back to you and tells you what they have been working on. How the heck would you know if its the right stuff, if the therapist knows what the heck they are doing, if they are making progress, or if you need to add medication aboard, unless you come from psych. Its like when a family doc refers a patient with shoulder/back pain to physical therapy without writing what to work on; they may know the patient needs physical therapy but not know if the patient is making progress or if further treatment is warranted or what is the expected outcome of the physical therapy(which may not be full recovery).

The healthcare professional most likely to know if a patient may benefit from physical therapy is a physical therapist. A well-trained physical therapist that knows his or her tests, undertakes a proper neurological screening to assess involvement of UMN/LMN, refers out or back when indicated, and keeps the provider in the loop is a PT worth keeping in touch with. Give us a bit of credit mate ;)

As a PT, we don't have the benefit of ordering diagnostic imaging or injections (military is an exception). We have our physical exam, patient hx, and any imaging results the patient brings in. If your PE and the imaging doesn't match, what are you most likely going to go off of to guide treatment?
 
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What's abnormal on an exam for LBP, HA, or FMS? If I had to pick between my intake questionnaire/Imaging/PDMP vs Exam in the CNP audience, I'd pick the former every time.
Which only goes to show u must do a lousy physical exam.

That you lump all low back pain together, and do not understand that there are both chemically or mechanically induced discogenic low back pain, facetogenic low back pain, and low back pain of SI jt etiology, speaks volumes.

Are u familiar with a facet loading maneuver? Gaenslen's? FABER? the Fortin finger test? Pelvic compression and distraction? FMS tender points? Cervicogenic headaches?
 
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this thread is turning into a non-sense "turf war"...my anesthesia chief used to say you can teach a monkey to intubate, but you can't teach a monkey to be a doctor (or a good doctor).

the bottom line is, physical exam, procedural skills are all manual skills that one can learn from reading and practicing. there's no point to say PMR is good at PE or anesthesiologist is good at procedure. They might have different focus in their training and therefore a stereotypically-viewed strength and weakness. on the other hand, a good pain doctor should be keenly aware of his strength/weakness and compensate it by constantly improving himself.

Is it the reason why this threat was started?
 
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Which only goes to show u must do a lousy physical exam.

That you lump all low back pain together, and do not understand that there are both chemically or mechanically induced discogenic low back pain, facetogenic low back pain, and low back pain of SI jt etiology, speaks volumes.

Are u familiar with a facet loading maneuver? Gaenslen's? FABER? the Fortin finger test? Pelvic compression and distraction? FMS tender points? Cervicogenic headaches?


Love the fortin finger test....especially when the third digit is used
 
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