History Of The Presenting Symptoms

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After greeting the patient, begin to establish a rapport and initiate your general assessment. Allow the patient to describe the symptoms voluntarily. The general assessment should include the following details concerning the character and intensity of the neuropathy or pain:

1. Onset and pattern: When did it start? How often does it occur?

2. Location: Where was the pain or neuropathy located?

3. Origin: What was the setting in which the pain developed? Was there trauma? Was it insidious?

4. Character: How does the patient describe the pain or neuropathy? What did it feel like? Was there numbness or a prickly sensation?

5. Intensity: How does the patient rate the pain? Use a visual analog scale from 0 to 10, with 0 being no pain and 10 being the most severe pain the patient has ever experienced (2).

6. Aggravating and relieving factors: What aggravates the pain? What relieves the pain? How does the pain respond following rest?

7. Previous treatment: What types of therapy have been tried? How did the pain or neuropathy respond to the therapy (3)?

Additional questions will form the basis for a detailed analysis of the course and development of the patient's symptoms. Determine whether the pain involves a focal area, or if there are multiple joints involved, for example, as found with rheu-matoid arthritis. Determine if there is a pattern to the pain or neuropathy. Find out whether the pain has disappeared from one or more joints, or if it has migrated, which may be associated with rheumatoid arthritis or sexually transmitted disease. Determine whether the pain varies over the course of the day, that is, if it is different in the morning than during the day or evening (4). Ask the patient whether the pain is associated with periods of inactivity, or if the patient perceives it as stiffness or resistance.

When evaluating pain in the back learn whether there are associated cord symptoms, such as loss of bladder or bowel control. Be alert for weakness, any inability to move a limb, or altered sensation. Changed sensations may be present, including tingling, prickling, warmth, or cold. The patient may also report an extremity "falling asleep," which occurs after compression of a nerve and may represent a paresthesia.

When evaluating patients, be mindful of cultural differences and traditions. There may be unique needs and circumstances of patients from various ethnic and cultural backgrounds as well as different age groups. Help from a translator can facilitate effective communication.

From: Interventional Radiology of the Spine

Edited by J. Kevin McGraw © Humana Press Inc., Totowa, NJ.

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