Wiki pain as a vital?

[anneabel]

Can anyone tell me if pain assessment can be counted as a vital in the constitutional system? Or if it doesn't count there, does it count anywhere?

 

[mshay134]

I believe that pain would fall under HPI as in description of location, quality, severity, timing, context, modifying factors and associated signs and symptoms.

 

[btadlock1]

Can anyone tell me if pain assessment can be counted as a vital in the constitutional system? Or if it doesn't count there, does it count anywhere?

Pain is a constitutional symptom, but it's given credit with the area/organ causing it. It is given credit in the history, because it is described subjectively by the patient - it's either the chief complaint, with HPI giving specifics (eg, 'back pain' for location, 'aching or stabbing pain' for quality, 'an 8 on the pain scale' for severity, etc.), or it's an associated sign/symptom (eg, patient with a swollen knee that is also painful).

For the ROS/exam, it's credited where it's identified: 'sore throat' in ROS is counted under ENT, and 'leg pain' would be considered musculoskeletal. The same goes for the exam - under 1997 guidelines, several bullets in the multi-system exam actually mention pain specifically, such as under the gastrointestinal portion (examination of abdomen, with notations of any tenderness) - it's generally referred to as "tenderness" versus pain, because the exam is meant to be objective (from the physician's point of view), and he can observe the patient's reaction to tenderness in specific locations that he's moving or prodding, but it's difficult for him to identify/quantify "pain", since he can't feel it in the same way that the patient does. Hope that made sense!