Symptom Finder - Pain
Pain
Developing a list of causes of pain anywhere in the body is best achieved by first visualizing the anatomy of the area. For example, a 50-year-old
man presents with chest pain of 2 hours duration. The physician visualizes the chest and sees the lung, the heart, the esophagus, the mediastinum, the aorta, ribs, and the spine. With his or her knowledge of what is common, the physician can develop a useful list of the causes of the patient’s acute chest pain as follows:
1. Lungs: pulmonary infarction, pneumothorax
2. Heart: myocardial infarct, coronary insufficiency, pericarditis
3. Esophagus: reflux esophagitis or Mallory–Weiss syndrome
4. Mediastinum: mediastinitis
5. Aorta: dissecting aneurysm
6. Ribs: fracture, costochondritis
7. Spine: osteoarthritis, herniated disc, fracture
The astute clinician who is not in a hurry may want to go to a second step. This involves a more thorough consideration of the etiologies that
may affect each organ. It is helpful to have a mnemonic to help recall the etiologic categories. Any one will do, but the author has found the
mnemonic VINDICATE very useful in the differential diagnosis of pain.
Applying this mnemonic to the causes of acute chest pain will provide the following possibilities:
V—Vascular suggests myocardial infarction, coronary insufficiency,
pulmonary infarct, or dissecting aneurysm.
I—Inflammation suggests pericarditis or pleurisy.
N—Neoplasm might prompt the recall of a neoplasm affecting the pleura or pericardium such as mesothelioma, carcinoma of the lung, or
carcinoma of the esophagus.
D—Degenerative diseases do not usually cause pain so this would not suggest any possibilities.
I—Intoxication might suggest uremic pericarditis.
C—Congenital anomalies are not usually associated with pain in the chest either; however, Marfan syndrome is associated with a dissecting
aneurysm.
A—Autoimmune diseases would prompt the diagnosis of lupus pleuritis.
T—Trauma would suggest contusion or hemorrhage of the chest wall or pericardium or fracture of the spine.
E—Endocrinopathies would bring to mind a substernal thyroiditis.
Now, by combining the first and second steps in this process, one can make a very useful table of the differential diagnosis of chest pain. This is
the system. Although it may seem cumbersome at first, it can become automatic and second nature with use. The benefit of this system is that one can develop this list of possibilities while interviewing the patient and begin asking meaningful questions to eliminate some of these possibilities prior to the workup. That makes it cost-effective.
Developing a list of causes of pain anywhere in the body is best achieved by first visualizing the anatomy of the area. For example, a 50-year-old
man presents with chest pain of 2 hours duration. The physician visualizes the chest and sees the lung, the heart, the esophagus, the mediastinum, the aorta, ribs, and the spine. With his or her knowledge of what is common, the physician can develop a useful list of the causes of the patient’s acute chest pain as follows:
1. Lungs: pulmonary infarction, pneumothorax
2. Heart: myocardial infarct, coronary insufficiency, pericarditis
3. Esophagus: reflux esophagitis or Mallory–Weiss syndrome
4. Mediastinum: mediastinitis
5. Aorta: dissecting aneurysm
6. Ribs: fracture, costochondritis
7. Spine: osteoarthritis, herniated disc, fracture
The astute clinician who is not in a hurry may want to go to a second step. This involves a more thorough consideration of the etiologies that
may affect each organ. It is helpful to have a mnemonic to help recall the etiologic categories. Any one will do, but the author has found the
mnemonic VINDICATE very useful in the differential diagnosis of pain.
Applying this mnemonic to the causes of acute chest pain will provide the following possibilities:
V—Vascular suggests myocardial infarction, coronary insufficiency,
pulmonary infarct, or dissecting aneurysm.
I—Inflammation suggests pericarditis or pleurisy.
N—Neoplasm might prompt the recall of a neoplasm affecting the pleura or pericardium such as mesothelioma, carcinoma of the lung, or
carcinoma of the esophagus.
D—Degenerative diseases do not usually cause pain so this would not suggest any possibilities.
I—Intoxication might suggest uremic pericarditis.
C—Congenital anomalies are not usually associated with pain in the chest either; however, Marfan syndrome is associated with a dissecting
aneurysm.
A—Autoimmune diseases would prompt the diagnosis of lupus pleuritis.
T—Trauma would suggest contusion or hemorrhage of the chest wall or pericardium or fracture of the spine.
E—Endocrinopathies would bring to mind a substernal thyroiditis.
Now, by combining the first and second steps in this process, one can make a very useful table of the differential diagnosis of chest pain. This is
the system. Although it may seem cumbersome at first, it can become automatic and second nature with use. The benefit of this system is that one can develop this list of possibilities while interviewing the patient and begin asking meaningful questions to eliminate some of these possibilities prior to the workup. That makes it cost-effective.
