WHO currently defined as pain "An unpleasant sensory and emotional experience associated with a lesion present or potential, or described in terms of the"
The English Society of Pain (SED) arises as defición pain "An unpleasant sensory and emotional experience associated with a lesion present or potential, or described in terms of it, and if it persists, with no remedy available to alter the cause, a disease in itself"
pain is considered as a disease, chronic pain as such, fibromyalgia, CRPS, phantom limb ... It is accepted that the phenomenon of awareness is a persistent disease. And I find it curious that there was none still not convinced of this, use the pain as a diagnosis in his office.
In most cases the process does not constitute a very painful disease itself. The mechanisms of chronic pain are not always present. Some advocates a central nervous system involvement in varying degrees, both in acute and chronic, and may be so, but it would still have a basic mechanical disorder, for example. The pain is usually only one feature of the disorder, not a disorder in itself. Nor does it take into account the inhomogeneity of patient groups with pain in one area. We consider the pains diagnostics and not as symptoms:
- My back hurts
- you have back pain
- But it hurts me also above
- Yeah, well ... dorso-lumbar pain, which I must say
- Actually, the neck also hurts
- you have back pain.
- already good, but I also goes here.
- you have "totalgia."
- Well let me calmer
Diagnostics as totalgia "or" foot catastrophic "to me sound like pitorreo. Pain is the symptom that the patient speaks, so based on that diagnosis is as if the patient himself should give the diagnosis. While I understand that he is a symptomatic diagnosis classification is useful and sometimes is as honest as you can say. I remember an entry from a colleague on her blog Diary of a physiotherapist, called Diagnosis ... indifferential. I loved the title. That is exactly how I let these diagnoses: Indifferent.
- My back hurts
- you have back pain
- what does that mean?
- Well, your back hurts
- But ... "That's my diagnosis?
- is generic diagnosis. Determines whether the subject is ill or not. It should be possible to have a simulation and the neurosis and hysteria. But relax, I decided that yes it hurts.
- Phew, luckily it. But ... Do you know why?
- I'm afraid that no one knows. What you asked me a specific diagnosis, but that is not what I can offer.
- Well, not be ruled out that it was something bad, do not know ...
- says A differential diagnosis? Do not worry so much that is not
- is that if I knew what I have bad ...
- Ah, well, you want a diagnosis anatomopatogenético. We'll send a radiograph. For now takes the symptomatic diagnosis.
- Sounds good ... BACK PAIN
back pain differential diagnosis is differentiates it hurts the lower back of no. I understand the difficulty of diagnosis and understand the need for classification of the diseases to be addressed. Some authors like McKenzie proposed a classification mechanical problems in what they call method Mechanical Diagnosis and Therapy (MDT), which already provides more information than that low back pain by example.
demand The patient diagnosis. Requires an explanation for their ailments. For that goes to consultation.
- You know that's what the expert.
quick answers for everything. Some constant repetition lies just seems true. Sometimes the arrogance and stubbornness is imposed on the reality of the patient.
- might not happen it will. Should have improved now.
No clinical-radiologic correlation. There are no pathognomonic test. No test is perfect. Everyone has their false positives and false negatives. It seeks maximum sensitivity and specificity. We search for the ideal. Prepare an assessment is always an ambitious project. Sometimes an accurate diagnosis is challenging because not all that ... if the treatment will be the same. Sometimes that Low back pain is the most honest, but at the bottom is because the therapeutic option is totally unspecified. And this is the most serious that we have. There is still much to do ...
- you have back pain
- What do I do?
- Rest and anti-inflammatory
- No, thanks.
As Maitland said: Make the features fit. ( "Making things fit") the theoretical part, based on squared defined diseases and the clinical signs and symptoms the patient reports, must "fit." When all tracks, all the tests, all tests point toward a direction we can say that "maybe", "every indication" ... Sometimes the problem is that we try to fit what happens to the patient within our finite knowledge, because "no I know "is not acceptable by either party.
I just know that I know nothing. It was the voice of someone who knew enough to realize this great truth. The more we know, the more we realize we do not know. Socrates
Learning to read is the first critical step to MBE. I believe in something, but I do not know that ... I must be agnostic.
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