Do you address referred spinal nerve pain?

[mycrofft]

Insult at most levels can create subjective pain (is there any other sort except factitious?) somewhere else. Costochondritis is notorious for mimicking mediastinal pain (heart, eosophagus), sacral impingement creating butt and thigh pain. Cervical narrowing can create the impression of arm pain similar to that sometimes described by pt's having a MI.

Do you have knowledge or protocols to , say, see if taking a rink of water makes chest pain change, or palpating the spine, or pressing o the sternum and seeing if the pain is changed? Percuss over the kidneys? Palpate for muscular asymmetry?

PS: That little blue are in the lower front labelled S4? Take it seriously, trust me.

 

[mycrofft]

Apparently not.

THat is a sort of off-putting diagram isn't it?

 

[BrushBunny91]

I think thats why no one is replying.

 

[JPINFV]

Not really. The most complicated part is the arm, but that's as easy as 5, 6, 7, 8, 1, 2.

My question is what can most EMS providers do for referred pain? Sure, as a DO student, checking for paraspinal fullness and other 'somatic dysfunction' is part and parcel for my training, as well as addressing it. However, until I get my DO, you aren't going to see me doing any OMM in an ambulance, and even still I don't see OMM making up even a minority of my practice.

 

[bstone]

I read a recently survey of DO students and practicing DOs who say that OMM is practiced by maybe 2% of them.

At the same time, a friend who is a DO recent adjusted my back when I was in some serious pain. I had maxed out on ibuprofen and was about to have my internist write me a script for some Vicodin. DO friend examined me, adjusted me and the pain was *gone*.

 

[JPINFV]

The problem with OMM is that there are a handful of techniques that are rather fanciful, a handful of techniques that sound fanciful, but work (damn you counterstrain. I don't fully agree with the mechanism, but damn it... it works), and a handful of techniques that are now considered evidence based (including treating backpain).

Similarly, most DOs and DO students seems to be either in the "it's all bunk" camp or the "you can treat everything with it!" camp.

Now throw in the issue that it can be time intensive and needs to be used regularly to be really proficient at it, and individual physicians probably aren't going to use a ton of OMT in their practice.

 

[bstone]

^ That sounds about right.

 

[mycrofft]

How about trying to r/o cardiac versus chest wall pain?

or such. TIme after time I was able to avoid pulling the big red lever by having the pt take a swallow of water or Maalox, or I would palpate sternum and T spine, or have them move their head (arm pain), which with fair to good VS and regular pulse, told me the most likely reason was not cardiac.
I sat in an ER for four hours and shelled out $500 because my GP did not compare a new EKG versus a three month old one for interval changes. A couple Advil, an ice bag and some Zantac would have done the job.

 

[bstone]

Costochondritis is treated with ibuprofen, ice and rest. I wonder how many cases of costochondritis are confused with rule out MI every year.

 

[mycrofft]

Many many misdiagnoses.

Mine was a capital example.