• Pain Med · Aug 2022

    Review

    An Algorithmic Approach to the Physical Exam for the Pain Medicine Practitioner; A Review of the Literature with Multidisciplinary Consensus.

    • Sayed E Wahezi, Robert Duarte, Chong Kim, Nalini Sehgal, Charles Argoff, Kristina Michaud, Michael Luu, Joseph Gonnella, and Lynn Kohan.
    • Department of Physical Medicine and Rehabilitation, Montefiore Medical Center, Bronx, New York, USA.
    • Pain Med. 2022 Aug 31; 23 (9): 1489-1528.

    BackgroundIncreased utilization of telemedicine has created a need for supplemental pain medicine education, especially for the virtual physical assessment of the pain patient. Traditional clinical training utilizes manual and tactile approaches to the physical examination. Telemedicine limits this approach and thus alternative adaptations are necessary to acquire information needed for sound clinical judgement and development of a treatment plan. Clinical assessment of pain is often challenging given the myriad of underlying etiologies contributing to the sensory experience. The COVID-19 pandemic has led to a dramatic increase in the use of virtual and telemedicine visits, further complicating the ease of assessing patients in pain. The increased reliance on telemedicine visits requires clinicians to develop skills to obtain objective information from afar. While eliciting a comprehensive history and medication assessment are performed in a standard fashion via telemedicine, a virtual targeted physical examination is a new endeavor in our current times. In order to appropriately diagnose and treat patients not directly in front of you, a pivot in education adaptations are necessary.ObjectiveTo summarize best care practices in the telemedicine physical exam while presenting an algorithmic approach towards virtual assessment for the pain practitioner.DesignReview of the literature and expert multidisciplinary panel opinion.SettingNationally recognized academic tertiary care centers.SubjectsMultidisciplinary academic experts in pain medicine.MethodsExpert consensus opinion from the literature review.ResultsAn algorithm for the virtual physical exam for pain physicians was created using literature review and multidisciplinary expert opinion.ConclusionsThe authors here present simple, comprehensive algorithms for physical exam evaluations for the pain physician stemming from a review of the literature.© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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