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Pain

Clinician bias in pain care for children: The emperor and his clothing revisited

AAPA Health Disparities Work Group April 10, 2012

A recent study shows that clinician bias leads to unequal pain care in children, but clinician avoidance of why this is so is the real problem.

Ask a Librarian!—February 2012

Jim Anderson, PA-C, ATC, Susan Klawansky, MLS, AHIP February 14, 2012

This month, our medical librarian-PA team answers questions about pain resources and how to impose search limits on Medline and other databases.

A rare cause of hip pain characterized by an inability to walk or bear weight

Troy Wagner, PA-C September 26, 2011

With no history of trauma, a middle-age man experiences severe pain in his left hip and  buttock. After common conditions are excluded, an unusual diagnosis is finally made.

Progressive paresthesias and pain in the extremities, chest, and abdomen following a seizure

Jason G. Homer, PA-C February 16, 2011

Two weeks after a grand mal seizure, a male patient presents to neurology with numbness, posterior neck pain, and trouble with balance.

Isolated compartment syndrome of the extensor carpi ulnaris muscle

February 01, 2011

After a cast is placed for a metacarpal fracture of the right forearm, a man presents with extreme pain in the dorsal aspect of the arm.

A misleading resting ECG in a patient with left bundle branch block

Rami N. Khouzam, MD, FACC, FACP, FASNC, M.J. Gallahan, PhD, PA-C? January 24, 2011

A female patient who experienced pain when she exerted herself had normal ECG findings.  Although rare, exercise may cause LBBB.

Persistent burning pain in the upper middle abdomen

Phillip Todd Smith, MHS, PA-C, MT(ASCP) October 29, 2010

A patient presents with a 3-month history of burning epigastric pain. CT and PET scans help identify the cause.

Abdominal mass and pain in a patient with pancreatitis

Robin L. Peacock; Urvi Shah, MD; Andres C. Marte-Grau, MD; Rathnakar Sherigar, MD October 26, 2010

A male patient with a history significant for pancreatitis, alcohol dependence, and smoking presents with left-sided abdominal pain and vomiting.

Thymoma: An uncommon cause of persistent anterior wall chest pain

Justin H. Ezell, MPAS, PA-C, Major Alcario Serros, DO October 18, 2010

Previously diagnosed as costochondritis, chest pain that persisted despite treatment prompted a search for an alternate diagnosis.

A 71-year-old woman with severe lower back pain and abdominal cramping

Monique Beyerle, MPAS, PA-C, AT-C September 24, 2010

A 71-year-old female presents with complaints of persistent severe back pain, abdominal cramping, and nausea.

A cracking sensation is the onset of severe ankle pain

Craig Roorda, PA-C September 21, 2010

Persistent ankle pain leads to a stress fracture diagnosis, but the patient's history suggests that something else is going on.

Left flank pain following cardiac catheterization

R. Steve Andrews, RRT; Andres C. Marte-Grau, MD; Rathnakar Sherigar, MD; Jennifer Pitts Hanopole; Urvi R. Shah, MD August 24, 2010

This patient's condition highlights the importance of paying close attention to history and not ruling out a rare complication of a procedure.

Painful subcutaneous abdominal mass in a woman with a history of cesarean section

Rene Frasher, DHSc, PA-C June 07, 2010

Years of worsening pain in a surgical scar proved baffling until an MRI revealed a soft-tissue mass in an uncommon location.

Vomiting and apparent discomfort in an 11-month-old girl

Michelle Jacobs, RPA-C April 26, 2010

The baby's physical reaction to her symptoms led to the diagnostic imaging that identified the problem.

Eyes wide shut: Can casual use of medical evidence cause harm and erode bioethical values?

Jim Anderson, PA-C, ATC, Diane Bruessow, RPA-C, DFAAPA, F. J. Gianola, PA, DFAAPA April 23, 2010

A complex patient case illustrates a range of societal and clinical biases and the impact these biases can have on patient care.

Bilateral shoulder pain developing after a hypoglycemic seizure

Captain Christopher L. Furbee, PA-C, MPAS; Colonel David A. Brown, MD December 07, 2009

Posterior shoulder dislocations are hard to diagnose because of their rarity. Your ability to interpret the appropriate radiographs is key.

Why won't this rash respond to treatment?

Joe R. Monroe, PA-C, MPAS December 04, 2009

This patient had chronic conditions she managed with a combination of clinical and self treatments. Is one of them perpetuating her rash?

A 2-week history of painful urination

Jodi Welt, MA, RD, PA-C; Ellen D. Mandel, DMH, PA-C November 24, 2009

An otherwise healthy 6-year-old boy presents with nonspecific abdominal pain. Recent voiding behaviors were the most definitive clues to this diagnosis.

How I learned to rate pain

Pamela Gervais, PA-C, MHS October 13, 2009

This physician assistant learns a valuable lesson on how difficult it can be to describe pain when she becomes a patient with acute abdominal pain.

PTSD: How to recognize the many faces of this hidden disorder

James E. Meyer, MD, FACP September 02, 2009

A broad view of the etiology of PTSD can help clinicians take a more effective approach to diagnosis and treatment.

Sudden onset of substernal chest pain in a college student at rest

David F. Irvine, DHSc, RPA-C; Wilson Crone, MD, PhD June 08, 2009

Despite its name, spontaneous pneumomediastinum may be associated with a number of factors.

How to perform a comprehensive examination of the knee

LT Kerri Browne, MSBS, PA-C, CDR Christopher A. Kurtz, MD June 01, 2009

This step-by-step guide describes a thorough knee examination that will lead to an accurate diagnosis of knee pathology.

Patellofemoral syndrome: How to perform a basic knee evaluation

Judi Lynn Price, BA, BS-PA, MPAS, PA December 01, 2008

The complexity of this joint makes it more susceptible to injury. An understanding of the biomechanics of the knee is instrumental when assessing patients' injuries.

Longstanding anterior pelvic pain

Chris A. Webb, MS, PA-C; Matthew L. Jimenez,MD December 01, 2008

The patient is a 74-year-old white woman who presented with complaints of longstanding anterior pelvic pain over the symphysis pubis. She reported a baseline dull and aching pain but experienced sharp, stabbing sensations at the pubic symphysis when performing benign activities such as rising from a seated position or getting in and out of her car.

A common cause of knee pain in athletic children

Denise Rizzolo, PA-C, PhD, Hilary Sugar; Stanley C. Parman, MD November 01, 2008

A 13-year-old female presented with a 4-day history of left knee pain. The pain had come on suddenly. The patient stated that after she walked home from school, she had some moderate knee discomfort; then, after dinner, she noticed increased pain and swelling just below her patella.

An unusual cause of low back and hip pain in a 20-year-old female

George A. Barbee, DSc, PA-C, CPT, SP October 01, 2008

Case Report - This patients symptoms turned out to be from an uncommon conditionbut one that should always be considered in the evaluation of abdominal pain in adults.

On the OxyContin scandal: Don't abandon patients in pain

Sarah Zarbock, PA-C July 01, 2007

Purdue Pharma recently announced a resolution to a 4-year investigation involving the promotion of OxyContin tablets.

Evaluation and treatment of patients with low back pain

Cpt. Alan Nelson, MPAS, PA-C April 01, 2007

Most back pain resolves promptly and spontaneously, and conservative treatment is effective in most cases that do not. Only in rare instances is this condition a sign of severe disease.

A routine ECG reveals new-onset bradycardia in an elderly man

Justine Isabel, PA-C; John C. Champion, MD December 01, 2006

A 70-year-old man presents to his primary oncologist to consider new chemotherapy to treat relapsed chronic lymphocytic leukemia. During the assessment, a routine ECG reveals new-onset bradycardia. The patient is sent to our cardiology clinic for further evaluation. In our clinic, he describes a 1-day history of increasing exertional dyspnea, fatigue, bilateral flank pain, and dark tea-colored urine. He denies nausea, vomiting, chest pain, fever, or syncope.

Difficult-to-diagnose pelvic pain

Julie Vajnar, PA-C, RT June 01, 2006

The patient is a 34-year-old woman who has been seeing you about chronic pelvic pain for some time now. You have performed a thorough workup. You have ruled out fibroids, endometriosis, and inflammation, but you cannot seem to find a source for the patient's pain. There is no evidence of bowel disease, such as Crohn's disease, or of appendicitis.