DD Chapter 3

Referred pain patterns associated with impairment of the spleen can produce musculoskeletal symptoms in:

(a) Left shoulder pain associated with damage or injury to the spleen is called Kehr's sign.

Pain (especially intense bone pain) that is disproportionately relieved by aspirin can be a symptom of:

(a) Neoplasm, in particular, primary bone cancer

Words used to describe neurogenic pain often include:

(b) Throbbing, pounding, and beating Aching, heavy, and sore are words = musculoskeletal pain. According to the McGill Pain Questionnaire, words like agonizing, piercing, and unbearable convey more emotional content than is communicated by actual descriptors of organic disease.

Pain of a viscerogenic nature is not relieved by a change in position.

False Some types of viscerogenic pain can be relieved by a change in position early in the disease process. For example, pain from an inflammatory or infectious process that affects the kidney may be reduced by leaning toward the involved side and applying pressure to that area. Gallbladder pain is sometimes relieved by leaning forward. Cardiac pain brought on by use of the upper extremities overhead may be relieved by bringing the arms back down to the sides.

Associated signs and symptoms are a major red flag for pain of a systemic or visceral origin compared to musculoskeletal pain.

True

Referred pain from the viscera can occur alone but is usually preceded by visceral pain when an organ is involved.

True Visceral involvement can occur without preceding or prodromal symptoms, but most often, associated signs and symptoms are present. Because visceral pain can be referred to the neck, back, or shoulder, the client who experiences gastrointestinal (GI) or genitourinary (GU) symptoms does not report these additional symptoms to the therapist when providing information about the musculoskeletal condition.

Bone pain associated with neoplasm is characterized by:

a. Increases with weight bearing Bone pain would be accompanied by a positive heel strike test. Symptoms of angina are sometimes relieved by antacids in women. Even if bone pain were caused by metastases from the GI tract, eating would not alleviate the symptoms.

Joint pain can be a reactive, delayed, or allergic response to:

a. Medications b. Chemicals c. Infections d. Artificial sweeteners (e.) All of the above

A 52-year-old woman with shoulder pain tells you that she has pain at night that awakens her. After asking a series of follow-up questions, you are able to determine that she had trouble falling asleep because her pain increases when she goes to bed. Once she falls asleep, she wakes up as soon as she rolls onto that side. What is the most likely explanation for this pain behavior?

a. Minimal distractions heighten a person's awareness of musculoskeletal discomfort. Pain that wakes a client up as soon as he or she rolls onto that side is indicative of an acute inflammatory process. Night pain associated with neoplasm is more likely to wake the client up after he or she falls asleep, when the tumor keeps normal tissue from obtaining essential blood and nutrients, thus creating tissue ischemia and subsequent pain. With chronic musculoskeletal conditions, the client can often get to sleep with just the right positioning and may even be able to sleep on that side for up to an hour or two before pressure and ischemia develop, causing pain.

What is the best follow-up question for someone who tells you that the pain is constant?

b. Do you have that pain right now?

A 48-year old man presented with low back pain of unknown cause. He works as a carpenter and says he is very active, has work-related mishaps (accidents and falls), and engages in repetitive motions of all kinds using his arms, back, and legs. The pain is intense when he has it, but it seems to come and go. He is not sure if eating makes the pain better or worse. He has lost his appetite because of the pain. After conducting an examination including a screening exam, the clinical presentation does not match the expected pattern for a musculoskeletal or neuromuscular problem. You refer him to a physician for medical testing. You find out later he had pancreatitis. What is the most likely explanation for this pain pattern?

d. Obstruction, irritation, or inflammation of the body of the pancreas distends the pancreas, thus applying pressure on the central respiratory diaphragm. Irritation of the retroperitoneal space begins when bleeding occurs behind the stomach, most often from a posterior duodenal ulcer. Rupture of the spleen causes Kehr's sign. The pancreas and low back structures are not formed from the same embryologic tissue. Disease of the pancreas, whether it involves the head, the body, or the tail, can put pressure on the corresponding portion of the respiratory diaphragm, resulting in shoulder or low back pain according to the location of the diaphragmatic irritation. Central diaphragmatic pressure results in referred pain to the ipsilateral shoulder; peripheral involvement of the diaphragm results in low back pain. This can occur in the right shoulder when the head of the pancreas is distended far enough, but it is more likely to affect the left shoulder via disease in the tail of the pancreas.