Sternbach Pain Thermometer

ghost02

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Has anyone else heard of this? I was reading a book on bedside diagnostic techniques and one that really stood out was one called the Sternback Pain Thermometer.

How it works is:
1. Have patient state pain 0-10
2. Apply blood pressure cuff and inflate to ischemic pressures (>250) and start a stopwatch.
3. Have the patient tell you when the pain sensed from the cuff is equal to their stated pain. Mark this time but continue the cuff and time. (T1)
4. When the patient removes the cuff or requests it to be removed, remove the cuff and mark that time. (T2

Divide T1/T2 and the fraction in decimal is the expected accurate pain.

So, stated 5/10 pain that was stated as reached at 50sec (T1) and then removed at 100 sec (t2) would have a fraction of 0.5, being the same as the patients stated pain.

Thoughts? Obviously tenuously applicable but interesting none the less.
 
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Summit

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Primum non nocere!
 

mgr22

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Thoughts? Obviously tenuously applicable but interesting none the less.
Thoughts? Here are a few:

1. Voodoo medicine.
2. Shouldn't be tried by anyone seeking an EMS career.
3. Arbitrary application of time parameters to the very subjective Borg scale; like cooking a turkey as long as it takes for a lambchop to defrost.
4. I'm not sure a BP cuff alone could reproduce 10/10 pain. You might have to stick progressively larger needles under the fingernails.
 

ghost02

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Its way less work to take them at their word and give them pain meds.
I'm of the same mentality but for differnet reasons, I'd rather have 10 people lie to me about the pain and get medication than 1 need it and not get it.

This is the first I've heard of this technique, no interest in using it of course but found it interesting.
 

Peak

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The ethics of causing limb ischemia to validate or invalidate a pain score is questionable at best in a specialty setting, and downright torture in the emergency setting.
 

Remi

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4. I'm not sure a BP cuff alone could reproduce 10/10 pain. You might have to stick progressively larger needles under the fingernails.
Tourniquet pain actually becomes excruciating after a bit of time.

Has anyone else heard of this? I was reading a book on bedside diagnostic techniques and one that really stood out was one called the Sternback Pain Thermometer.

How it works is:
1. Have patient state pain 0-10
2. Apply blood pressure cuff and inflate to ischemic pressures (>250) and start a stopwatch.
3. Have the patient tell you when the pain sensed from the cuff is equal to their stated pain. Mark this time but continue the cuff and time. (T1)
4. When the patient removes the cuff or requests it to be removed, remove the cuff and mark that time. (T2

Divide T1/T2 and the fraction in decimal is the expected accurate pain.

So, stated 5/10 pain that was stated as reached at 50sec (T1) and then removed at 100 sec (t2) would have a fraction of 0.5, being the same as the patients stated pain.

Thoughts? Obviously tenuously applicable but interesting none the less.
Has this technique ever been validated? I highly doubt it.

The limitation that will always exist with any pain assessment tool is that pain is highly subjective. I don’t see how this is any different.
 

akflightmedic

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Why would anyone ever even think of this? I mean what experiments took place to conceive this ridiculous process?

Pain is subjective. Pain is what the patient tells you it is. Treat as stated. Full Stop.
 

StCEMT

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People complain when the cuff does a normal cycle, much less leave it inflated at 230 for over a minute.
 

akflightmedic

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To the original poster, imagine this being done to you when you know you have some pain or an ache. Imagine doing this to your child when you suspect they are faking a tummy ache to avoid school. Seriously, I am still baffled how this can be posted and posed as a serious consideration as opposed to posting it and blasting it for the piece of crap it is.
 

ghost02

CA Kern Paramedic
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To the original poster, imagine this being done to you when you know you have some pain or an ache. Imagine doing this to your child when you suspect they are faking a tummy ache to avoid school. Seriously, I am still baffled how this can be posted and posed as a serious consideration as opposed to posting it and blasting it for the piece of crap it is.
Naturally I'm not advocating for its use, but was genuinely curious what others thought. I found it odd enough to post.
 

E tank

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That a pain scale uses the term for a device that measures temperature betrays a concerning lack of awareness as well....
 

Aprz

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Your chest pain will hurt less if I cut off all blood circulation to your arm.
This made me think of ischemic conditioning. Not to treat pain, but to reduce damage to the heart. Same thing, inflate a cuff, leave it fully inflated for minutes, deflate for a couple of minutes, and repeat until you arrive at the hospital. I wonder if there have been anymore studies on that. I thought it was interesting to read about.
 

E tank

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This made me think of ischemic conditioning. Not to treat pain, but to reduce damage to the heart. Same thing, inflate a cuff, leave it fully inflated for minutes, deflate for a couple of minutes, and repeat until you arrive at the hospital. I wonder if there have been anymore studies on that. I thought it was interesting to read about.
It's a thing...

 

Remi

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Why would anyone ever even think of this? I mean what experiments took place to conceive this ridiculous process?

Pain is subjective. Pain is what the patient tells you it is. Treat as stated. Full Stop.
I mean, there are plenty of reasons to attempt to develop a more objective method of quantifying pain. Patients do a terrible job of quantifying their own pain, for numerous reasons. I can think of several important problems with this technique, but there are probably lots of useful diagnostic tools that evolved from less useful ones.

Unfortunately, the idea that "pain is always what the patient says it is" has proven to be a woefully inadequate method of assessing pain. Adequate acute pain management is often achieved by simply giving the patient pain medicine until they say the feel better. But it's often a lot more complex than that, especially with non-acute pain.


To the original poster, imagine this being done to you when you know you have some pain or an ache. Imagine doing this to your child when you suspect they are faking a tummy ache to avoid school. Seriously, I am still baffled how this can be posted and posed as a serious consideration as opposed to posting it and blasting it for the piece of crap it is.
The intention of this tool is not to prove that people are faking pain. It is intended to provide a more objective picture of what a person is experiencing. Presumably it would be done with the patient's consent, and they can ask to have the cuff deflated (or deflate it themselves) at any time.
 

akflightmedic

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I can think of several important problems with this technique, but there are probably lots of useful diagnostic tools that evolved from less useful ones.

Unfortunately, the idea that "pain is always what the patient says it is" has proven to be a woefully inadequate method of assessing pain. Adequate acute pain management is often achieved by simply giving the patient pain medicine until they say the feel better. But it's often a lot more complex than that, especially with non-acute pain.
I will grant useful diagnostics evolved from horrible initial approaches or "less useful" ones. As for pain, it absolutely is what they say it is. This is why we treat what they say it is. I simply cannot wrap my head around a more objective approach aside from the scales in place (numeric, Wong, etc.). We have their vitals (not always helpful) and their statement/rating. Signs and symptoms are just too vague or too diverse to add much other than a conversation piece. Out of all the evidence or objective data we collect, nothing can trump the patient saying what they say. You know this, vitals do not trend accordingly in every patient, the femur fracture guy is smiling and joking while the paper cut laceration is crying. Pain is wrapped up in too much physiological and psychological present and past experiences to be a completely objective data point.

At the end of the day, regardless of what we see, what we measure, or how we feel...the pain is what the patient says it is (for now). :)
 

Remi

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I will grant useful diagnostics evolved from horrible initial approaches or "less useful" ones. As for pain, it absolutely is what they say it is. This is why we treat what they say it is. I simply cannot wrap my head around a more objective approach aside from the scales in place (numeric, Wong, etc.). We have their vitals (not always helpful) and their statement/rating. Signs and symptoms are just too vague or too diverse to add much other than a conversation piece. Out of all the evidence or objective data we collect, nothing can trump the patient saying what they say. You know this, vitals do not trend accordingly in every patient, the femur fracture guy is smiling and joking while the paper cut laceration is crying. Pain is wrapped up in too much physiological and psychological present and past experiences to be a completely objective data point.

At the end of the day, regardless of what we see, what we measure, or how we feel...the pain is what the patient says it is (for now). :)
Sorry, but that just isn’t true.

I would grant that in the acute setting, it is, for now, the only practical approach. And this is an EMS forum, after all.

But there’s a heck of a lot more going on with pain assessment and management than the 1-10 scale. Using such a blunt and simple approach to deal with such a complex issue has caused more than a few problems.
 

akflightmedic

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First, I am always open to being educated about what else is out there. However, right now, what we have are the scale/s and that truly is the only thing we generally treat at the moment. I mean you can bring in non-pharmaceutical treatment modalities and yes those have effect, however again we are not talking about the meds or therapies given for pain, we are talking about the pain measurement. And unless there is some new piece of information I have not yet been exposed to, then the pain is what they say it is and we treat accordingly.

If you disagree with that, then please tell me how you decide to medicate more or less and based on what data?
(Reads snarky but not intended that way)
 
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