Page 91 Guide to Pain Management in Low-Resource Settings

Chapter 11

Physical Examination: Neurology

Paul Kioy and Andreas Kopf

Why do a neurological examination? Find out the type of headache, its character, an-
atomical site, severity, frequency, and duration; the na-
Th e main objective in a neurological examination for ture of onset, timing and periodicity; precipitating fac-
a patient with pain is to identify the abnormality in tors (straining, coughing, posture, sex, etc.); relieving
the nervous system that may be related to the pain factors; and associations (visual, auditory, tactile, and
experience and separate central nervous from periph- dysautonomic associations etc.). Other symptoms can
eral nervous lesions. It is also important not only to largely be evaluated along the same lines with variations
establish a clinical diagnosis, but also to follow this up as necessary, since not all aspects apply to all symptoms.
with anatomical, pathophysiological, etiological, and A history of common neurological symptoms such as
possibly pathological diagnoses, if possible. Pain is the loss or impairment of consciousness, visual disturbanc-
most common reason that patients seek medical con- es, speech and language disturbances, sensory distur-
sultations, and it should be remembered that the pain bances, and motor disturbances (including sphincters)
may not be neurological. Indeed, in origin it often is should be obtained along the same lines where possible.
not. In a general overview, a quick evaluation of the Further details regarding individual symptoms can be
mental state and psychological makeup of the patient added as appropriate during direct questioning to es-
must be included as part of the neurological examina- tablish potential etiological factors, including exposure
tion as these factors may have a signifi cant impact on to drugs (alcohol included), environmental toxins, past
pain behavior. injuries, and systemic illnesses.
In the history, the presenting symptoms are In conclusion, at least basic neurological ex-
evaluated in the usual manner, which we exemplify here aminations are indicated in every patient to detect
using one of the most common symptoms in pain pa- somatic etiologies of pain, mainly lesions of the cere-
tients—headaches. Headaches are important as they brum, spinal cord, and peripheral nerves, including
are a very common type of pain and one that alerts pa- myopathies. Although in pain management the psy-
tients to a potential neurological problem, although for- chological factors and symptomatic treatment options
tunately the cause is rarely neurological. Headache still are emphasized, it is crucial for the adequate under-
calls for a thorough neurological examination, however, standing of the patient’s pain to take a thorough his-
as missing those uncommon neurological headaches tory and perform a thorough physical examination.
(raised intracranial pressure, meningitis, tumors, etc.) It would be harmful to our patients to overlook pain
may have catastrophic consequences. etiologies that could be treated causatively! Th erefore,

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 79
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
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recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.