Patient Education: Explain Musculoskeletal Ultrasound
The objectives of a Physical Medicine & Rehabilitation consultation:
1) Detect dangerous conditions.
2) Identify barriers to success or risk factors for chronic disability.
3) Utilize diagnostic tests efficiently.
4) Initiating appropriate treatment.
Physical exam and radiographic studies may identify opportunities for procedural interventions or surgery, but these findings often do not correlate with symptom severity, degree of disability or appropriate intensity of treatment. [IID]*
Imaging Studies
Patient Education: MRI
Video MRI - What to Expect
Low Back Pain
ACUTE:
X-rays, MRI, or CT scan are not recommended for routine evaluation
within the first 4-6 weeks of symptoms unless a red flag and high index
of suspicion is noted on clinical evaluation.If radicular pain without weakness does not improve by > 3 weeks obtain MRI [IIB*]. If not diagnostic, obtain EMG.
CHRONIC: 30% of asymptomatic volunteers have disk
changes on MRI. Neither the radiologist's report of
'stenosis' nor measures of the spinal canal on imaging are
useful in positively diagnosing the clinical syndrome of
spinal stenosis. Low-grade spondylolisthesis noted on x-
ray are most often asymptomatic. In these cases diagnostic
tests must be interpreted in conjunction with the clinical
history and physical examination.
Electrodiagnostic Testing
Patient Education: Explain Electrodiagnostic Testing (Nerve Conduction Studies & EMG)
Chronic Pain Assessment
Acute pain and chronic pain are fundamentally different
processes and must be evaluated differently. Acute pain
assessment seeks to identify its underlying injury or disease
and treat it, thereby eliminating both the pain and the need
for pain management. Pain intensity, quality and location
are core to acute pain assessment, and reduction of pain
intensity is the primary outcome measure of acute pain
interventions.
In contrast, chronic pain is the disease itself, and, in many cases will not resolve. Chronic pain evaluation thus focuses on assessing function and co-morbidities, rather than merely intensity, quality and location. Pain disability refers to the impact of chronic pain on function, and should be assessed as a basis for setting treatment goals. Pain beliefs are important to evaluate as well, particularly for patients who have had difficulty adjusting to living and with chronic pain. Additionally, a detailed pain and treatment history is necessary to identify potential problems and opportunities for success in ongoing management.
Pain intensity. Pain scores, though useful in assessing and treating acute pain, have a limited role in treating chronic pain. While chronic pain intensity is important to assess, patients should understand that reducing pain intensity will not be the sole focus of evaluation or management. This requires both a shift in expectations for many patients accustomed to an acute pain management model, as well as a direct, consistent approach from providers.
Common pain intensity assessment tools include the Numerical Pain Rating Scale (NPRS), where the patient rates pain on a numerical scale, and the Visual Analogue Scale (VAS), upon which the patient places a mark along a 10 cm horizontal line to reflect pain severity. Both scales require verbal anchors (typically “no pain at all” for the left anchor (or “0”) and “the most severe pain you can imagine” on the right (or “10”). For the NPRS, a 10-point rating scale is recommended. The health care provider may verbally provide the anchors and ask the patient to rate the level of pain on the 10–point scale. See examples below.
In contrast, chronic pain is the disease itself, and, in many cases will not resolve. Chronic pain evaluation thus focuses on assessing function and co-morbidities, rather than merely intensity, quality and location. Pain disability refers to the impact of chronic pain on function, and should be assessed as a basis for setting treatment goals. Pain beliefs are important to evaluate as well, particularly for patients who have had difficulty adjusting to living and with chronic pain. Additionally, a detailed pain and treatment history is necessary to identify potential problems and opportunities for success in ongoing management.
Pain intensity. Pain scores, though useful in assessing and treating acute pain, have a limited role in treating chronic pain. While chronic pain intensity is important to assess, patients should understand that reducing pain intensity will not be the sole focus of evaluation or management. This requires both a shift in expectations for many patients accustomed to an acute pain management model, as well as a direct, consistent approach from providers.
Common pain intensity assessment tools include the Numerical Pain Rating Scale (NPRS), where the patient rates pain on a numerical scale, and the Visual Analogue Scale (VAS), upon which the patient places a mark along a 10 cm horizontal line to reflect pain severity. Both scales require verbal anchors (typically “no pain at all” for the left anchor (or “0”) and “the most severe pain you can imagine” on the right (or “10”). For the NPRS, a 10-point rating scale is recommended. The health care provider may verbally provide the anchors and ask the patient to rate the level of pain on the 10–point scale. See examples below.
Functional Assessment Tools
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