April 6, 2025
Neuropathic Pain Made Simple: What Every Clinician Should Know
šļø Have you ever treated someone with what seemed like a typical MSK problemābut the pain just didnāt add up? Burning, zinging, unpredictable symptoms? In this episode, Mark Kargela breaks down the clinical presentation of neuropathic pain, how to screen for it confidently, and 4 common mistakes that lead to missed diagnoses.
ā
Learn how to distinguish neuropathic from nociceptive and nociplastic pain
ā
Use simple tools like a paperclip and a coin to screen for small fiber dysfunction
ā
Understand how to palpate nerves (not trigger points) and recognize their sensitivity
ā
Get clarity on terms like somatic referred pain, radicular pain, and radiculopathy
š„ Download the free Neuropathic Pain Screening Cheat Sheet here:
š https://modernpaincare.com/neuropathic
š Related Papers:
Terminology IASP paper
Validity of Small Fiber TestsĀ
Neuropathic Pain Grading System
*********************************************************************
šø - Follow us on Instagram - https://www.instagram.com/modernpaincare/
š¦ - Follow us on Twitter - https://www.twitter.com/modernpaincare/
šļø - Listen to our Podcast - https://www.modernpaincare.com
____________________________________
Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness
WEBVTT
00:00:00.143 --> 00:00:03.713
Have you ever treated someone with what seemed like a simple musculoskeletal issue?
00:00:03.983 --> 00:00:08.034
Maybe shoulder pain, foot pain, or low back pain, but things just weren't adding up?
00:00:08.333 --> 00:00:12.114
The pain felt disproportionate, unpredictable, maybe even burning or zinging.
00:00:12.114 --> 00:00:15.054
And deep down you wondered, could this be nerve related?
00:00:15.954 --> 00:00:17.333
But then comes the frustration.
00:00:17.454 --> 00:00:22.344
You're not quite confident in how to test for nerve involvement beyond the standard sensory strength and reflex checks.
00:00:22.853 --> 00:00:24.954
So either move on or second guess yourself.
00:00:24.954 --> 00:00:30.294
And as a result, the patient continues to struggle and they may miss out on the targeted care they actually need.
00:00:31.103 --> 00:00:31.794
You're not alone.
00:00:31.794 --> 00:00:33.444
And today we're gonna change that we're.
00:00:34.359 --> 00:00:40.209
Welcome to the Modern Pain Podcast, where we help you make sense of pain and bring more clarity and confidence to your clinical practice.
00:00:40.509 --> 00:00:51.488
I'm your host, Mark Kargela, and in this episode we're gonna take a practical, deep dive into neuropathic pain, what it is, how it shows up, and how you can screen for it with confidence even without fancy equipment.
00:00:52.298 --> 00:00:57.399
You'll learn the true nature of neuropathic pain and how it differs from nociceptive and noci plastic pain.
00:00:57.819 --> 00:01:04.328
A simple pathway to recognize it in the clinic, and four common mistakes clinicians make that lead to misdiagnosis or mismanagement.
00:01:04.899 --> 00:01:12.998
Plus I've created a free clinical cheat sheet you can download that walks you through how to screen for small fiber changes at the bedside with just a coin and a paperclip.
00:01:13.569 --> 00:01:19.269
Grab that now at modern pain care.com/neuropathic or check the link in the show notes.
00:01:19.968 --> 00:01:21.287
Let's get into today's episode.
00:01:21.721 --> 00:01:25.561
This is the Modern Pain Podcast with Mark Kargela.
00:01:26.495 --> 00:01:29.766
So let's look at a study, and this was back in 2012.
00:01:29.766 --> 00:01:32.615
It's a study by Keith Smart and his colleagues, and it's still used quite a bit.
00:01:32.615 --> 00:01:33.906
It was introduced to me in fellowship.
00:01:33.906 --> 00:01:44.301
There's probably some more papers recently, but I do think this paper is one of the first ones to really lay out some clinical groupings of what do we see in a subjective and a clinical exam that can help somebody who's got neuropathic pain.
00:01:44.301 --> 00:01:46.415
So let's look at the subjective components first.
00:01:46.835 --> 00:01:53.195
You might see the patient describing pain as burning, shooting sharp, aching, electric shock, like ants crawling on their skin.
00:01:53.195 --> 00:01:57.486
Those kind of weird symptoms that don't seem like they line up with maybe a local tissue issue.
00:01:58.146 --> 00:02:03.195
They might have a history of a nerve injury or mechanical compromise, maybe a compression injury or something like that.
00:02:03.376 --> 00:02:09.885
They also might have some medical conditions diabetes, diabetic neuropathy, those type of things we should be looking out for in their history as well.
00:02:10.336 --> 00:02:19.306
They have pain in association with other neurologic symptoms such as the pins and needles, maybe numbness, weakness, things that we commonly see in clinic when we're thinking about possible nerve involvement.
00:02:19.980 --> 00:02:23.251
The pain would be referred in a dermatome and cutaneous distribution.
00:02:23.251 --> 00:02:34.290
So this is again where we need to know nerve root distributions, peripheral nerve distribution, just so we can understand where maybe these pains are distributing in something that would be suspicious for a nerve versus, Hey, this is a local tissue issue.
00:02:34.290 --> 00:02:34.350
I.
00:02:35.656 --> 00:02:40.906
These symptoms, patients will often say they're not really responding well to NSAIDs, such as, ibuprofen, those type of things.
00:02:41.135 --> 00:02:49.906
The things that we would expect if it was a primary inflammatory nociceptive issue that would ideally be helping, but we're hearing in the history as we're speaking to these folks, that it isn't really helping much.
00:02:50.506 --> 00:03:05.725
You might hear that the patient, if the physician may, that maybe referred them or who's also been managing them, maybe put them on duloxetine or Pregabalin might be seeing that they're having some improvements with that, which again, at that point, probably neuropathic pain has already been diagnosed.
00:03:06.746 --> 00:03:10.406
You're gonna often see with these people pain of high severity and irritability.
00:03:10.406 --> 00:03:23.545
So that a lot of times you gotta be very cautious as we examine these folks that we're not getting significantly aggressive with our physical examinations, just because often these symptoms don't take much to provoke and they can often be a little bit of a difficult thing to settle.
00:03:23.846 --> 00:03:30.295
So as you're working and having people move or maybe doing things with exercise, you're instructing those folks, Hey, let me know when we're just getting to the edge of things.
00:03:30.295 --> 00:03:31.735
I don't want you to push into symptoms today.
00:03:31.735 --> 00:03:35.066
I want you just to go to the edge to where you're just maybe nudging into some things.
00:03:35.161 --> 00:03:41.431
Next we're gonna see maybe a mechanical pattern to aggravating and easing factors that involves things that load or compress nerve roots.
00:03:41.431 --> 00:03:45.811
So anything that kind of puts compression into maybe the nerve trunk of your sciatic digging into the back of your leg.
00:03:46.080 --> 00:03:49.980
Sometimes seats will do that for some people who have neuropathic pain in that distribution, I.
00:03:50.550 --> 00:03:56.401
You also might hear for the upper extremity neuropathic pain, anything reaching behind or reaching where they're put in tension.
00:03:56.640 --> 00:04:09.181
Oftentimes we mistake that painful arc, which we'll talk about later as a local tissue issue at the shoulder when we also know the painful arc is right in the realm of where Neurodynamic mechanical loading of that brachial plexus is probably at its peak.
00:04:09.681 --> 00:04:12.860
You also see pain in association with other dysesthesia.
00:04:12.860 --> 00:04:20.120
You get this crawling, heaviness, electrical sensations that again, just don't add up as a local tissue mechanical nociceptive issue.
00:04:20.886 --> 00:04:28.656
And then the one thing that I would also recommend you is like asking patients, can you just get pain just sitting there doing nothing like at rest, where you'll get these sudden bursts of pain.
00:04:29.026 --> 00:04:33.466
This is often a characteristic of neuropathic pain where patients can just say, I can just be laying down.
00:04:33.466 --> 00:04:34.456
I can be doing nothing.
00:04:34.815 --> 00:04:41.776
I will get these random, just pretty sharp, nasty jolts of pain that go into my leg or my arm, depending again where the patient's pain is located.
00:04:43.276 --> 00:04:49.365
So let's look at the clinical examination with these folks as well to see what kind of things we might see clinically with them.
00:04:55.935 --> 00:05:04.245
So with these patients, pain symptom provocation with mechanical movement tests, so again, our active and passive neurodynamic testing, straight leg raise, slump testing.
00:05:04.245 --> 00:05:11.235
You do your active upper limb nerve, you do your upper limb neurodynamic tests your median and your radial, your ulnar nerve testing.
00:05:11.730 --> 00:05:34.300
You'll also get pain and symptom provocation with palpation of relevant nerve tissues, and this is probably one area I see clinicians make a big mistake as they start palpating, down the areas of pain and they disassociate or misdiagnose these tender points as something that's a problem locally in the tissue, like a trigger point or something like that when this is probably the materializing of hypersensitivity in the distribution of the nerves.
00:05:34.300 --> 00:05:40.511
Ensure muscles might get hypersensitive and maybe increase their tone when the nerve that's supplying them is highly sensitive.
00:05:41.036 --> 00:05:42.925
We'll see positive neurologic findings.
00:05:42.975 --> 00:05:47.475
Decreased reflexes, sensation or muscle power in a dermatome or myoma distribution.
00:05:48.136 --> 00:05:57.975
We might also see antalgic posturing of the affected limb or body part where the patient's trying to find positions where they have to externally rotate their lower extremity to put some maybe mechanical slacking on the nerve.
00:05:57.975 --> 00:06:05.386
Or they might say the old shoulder abduction sign where somebody walks in your clinic or you might hear a patient say, when I rest my hand in my head, it's the only source of relief I get.
00:06:05.685 --> 00:06:07.966
Again, the thought with that is there might be some mechanical.
00:06:08.690 --> 00:06:11.901
Slacking or decreasing the mechanical load on that nerve.
00:06:12.350 --> 00:06:26.110
Then lastly, you might see positive findings of hyperalgesia, primary or secondary, or even allodynia where just sensations or stimuli that should be, light touch or things that should not have pain are hyper sensitive and you're getting pain with even light touch or things that shouldn't be that sensitive.
00:06:26.331 --> 00:06:42.891
This is a pathway that was developed by Annina Schmid and her colleagues as part of a neuropathic, pain special interest group for the International Associations for the Study of pain, where we can help clinicians kind of work through a pathway to help us determine, hey, is neuropathic pain present or not in this patient or this clinical situation.
00:06:42.891 --> 00:06:49.101
So obviously we're gonna have pain and then we talked about our history is gonna give us some clues that, hey, this might be present or not.
00:06:49.442 --> 00:06:56.572
You're gonna then move on to the examination, do some of the things that we'll talk about you're gonna do a sensory exam, you're gonna do mechanical loads to nerves.
00:06:56.572 --> 00:07:16.781
You can do palpatory assessments, you're gonna do all the things that we know how to do clinically to determine, you might look at spinal related movements, especially if it's spinal related leg pain, which was a context of this study where you're gonna have movements that might influence spinal positioning or things that if there is neuropathic pain being generated, possibly from a spinal condition, that we might have some altering of symptoms based on spinal positioning.
00:07:17.271 --> 00:07:28.851
And then complimentary tests are mainly for folks more in the physician realm where you're gonna see cts, MRIs, skin biopsies, other tests that are probably tests outside of your basic clinical practice in physical therapy.
00:07:29.122 --> 00:07:32.692
So I wanted to get into four issues, four mistakes.
00:07:32.692 --> 00:07:33.682
Some of these I've made.
00:07:33.682 --> 00:07:35.182
The one at the end, definitely I've made.
00:07:35.182 --> 00:07:39.023
Let's talk about some of the issues that we all face as clinicians or some of the mistakes we've made.
00:07:39.233 --> 00:07:40.103
I've made them all.
00:07:40.283 --> 00:07:42.692
You may be making them, or you're making them currently.
00:07:42.963 --> 00:07:43.952
That's why we're having this video.
00:07:43.952 --> 00:07:45.182
So hopefully these will help you out.
00:07:45.598 --> 00:07:48.778
First one, not thoroughly questioning out symptoms.
00:07:49.228 --> 00:07:51.987
So what does that mean when we're not thoroughly questioning out symptoms?
00:07:51.987 --> 00:07:58.408
Well, one, you need to not just'cause let's just say we have a patient with lateral elbow pain on the left and we just tunnel vision in.
00:07:58.408 --> 00:08:00.088
We question, we do all the palpating.
00:08:00.117 --> 00:08:09.348
'cause again, if there's nerve issues, you're gonna get tenderness at the lateral elbow, which if we're really anchored on this being a lateral elbow issue and a lateral epycondylgia you're gonna start digging and finding sensitivity.
00:08:09.348 --> 00:08:10.968
And, oop, my diagnosis is made.
00:08:10.968 --> 00:08:14.358
This is just a lateral epicondylgia, nociceptive dominant.
00:08:14.687 --> 00:08:17.358
But we want to question out like, where are these symptoms distributing?
00:08:17.358 --> 00:08:24.617
And I tell students that I mentor and clinicians I mentor, that you need to question out from the spine all the way down to the distal extremity through that area of symptoms.
00:08:24.617 --> 00:08:27.468
So any current or past symptoms in your neck or.
00:08:28.043 --> 00:08:33.543
Into your top of your shoulder, any symptoms in your upper arm, any symptoms in your lower arm, any numbness, tingling.
00:08:33.543 --> 00:08:37.023
We're gonna question all those things from the whole distribution of where a nerve could be.
00:08:37.322 --> 00:08:48.123
And it's just good common practice to do that where you're gonna ask these questions to understand if the patient says, yeah, I got this lateral elbow pain, I also have this pain on the outside of my wrist, and I got this pain on top of my shoulder.
00:08:48.852 --> 00:08:51.552
And recognize patients sometimes don't offer this information.
00:08:51.552 --> 00:08:53.592
They don't understand that there's a connection to this thing.
00:08:53.592 --> 00:08:58.033
They just, their pain may be worse at the elbow and that's where they find that they need to discuss with you.
00:08:58.033 --> 00:08:59.413
So they don't draw it on a body chart.
00:08:59.413 --> 00:09:02.423
They don't discuss it in clinic'cause they see that as separate issues.
00:09:02.423 --> 00:09:10.793
But us as a wise clinician or as somebody who understands neuropathic pain, you're gonna start hopefully connecting the dots that, hey, they got lateral wrist pain, lateral elbow pain, and neck pain.
00:09:10.793 --> 00:09:14.062
That sure lines up with a possible neuropathic pain condition.
00:09:14.186 --> 00:09:17.995
Next mistaking positive clinical exam findings is a local tissue issue.
00:09:17.995 --> 00:09:25.105
I've already alluded to this a little bit, but this is basically where the patient has tenderness throughout all sorts of areas.
00:09:25.105 --> 00:09:29.975
When you palpate it could be in the shoulder with a shoulder pain,'cause a lot of those nerve trunks truck right through the shoulder.
00:09:29.975 --> 00:09:35.206
So we might be mistaking, maybe rotator cuff or tendinopathy or, tendon type pathologies.
00:09:35.456 --> 00:09:41.765
You might be palpating along the course of the median nerve and the bicep or in the front of the elbow and you're thinking, okay, this is bicipital tendonitis.
00:09:41.765 --> 00:09:41.826
I.
00:09:42.676 --> 00:09:46.576
The big moral of that story is you need to palpate possibly throughout.
00:09:46.576 --> 00:09:54.466
If you're not sure if this is a local issue or not, then you would expect the tenderness to stay pretty local and focus to a tissue and you shouldn't see it tracing.
00:09:54.466 --> 00:09:58.666
And that's where you need to know where your nerve trunks distribute throughout the body, where you can have some access to'em.
00:09:58.666 --> 00:10:03.696
Obviously in the satic nerve, you can palpate down the trunks as it warms alongside, the hamstrings.
00:10:03.946 --> 00:10:10.515
You can, if you're really sadistic, you can do the bowring test where you're strumming the back of the knee in Slack, where you're putting a little twang on the satic nerve.
00:10:10.791 --> 00:10:12.110
Again, I wouldn't recommend doing that.
00:10:12.110 --> 00:10:14.630
If somebody's got a hot satic nerve, they're not gonna like you so much.
00:10:14.971 --> 00:10:26.280
But you need to make sure that when you're assessing for palpatory tenderness, that your at least thinking process needs to include that there's possibly that this sensitivity could be a widespread sensitivity of a nerve.
00:10:26.280 --> 00:10:28.260
Then it just expand your palpation.
00:10:28.291 --> 00:10:30.150
Maybe it is just locating itself there.
00:10:30.421 --> 00:10:31.951
It's not really distributing further.
00:10:31.951 --> 00:10:34.620
It's very focused and localized where we can be maybe more.
00:10:34.900 --> 00:10:43.931
Suspicious that it's nociceptive or a local tissue issue versus, Hey, I palpate and man, it's sensitive here, but I can palpate all the way down into some nerve distributions and palpate all the way up.
00:10:43.931 --> 00:10:46.030
And man, it is hypersensitive and tender.
00:10:46.721 --> 00:10:49.860
And as I mentioned earlier too, we can get clinicians who get anchored into a.
00:10:50.910 --> 00:11:05.331
Treating these local downstream sensitive issues where they got things that get characterized as trigger points or things where I'm poking needles, I'm driving my knuckle, I'm doing scraping techniques, and granted, those actually can probably impact neuropathic pain.
00:11:05.331 --> 00:11:16.041
But if we're working with somebody, for instance, who's got a herniated disc at the neck and downstream is where all the sensitivity and pain is, and you're just focusing downstream with all these peripheral techniques.
00:11:16.566 --> 00:11:23.255
You might manage their pain that and take a while as maybe the natural history of the thing going on in their neck does its thing.
00:11:23.255 --> 00:11:26.826
And over time, that quiets down and the pain kind of gets in a good spot.
00:11:27.365 --> 00:11:28.985
But maybe you're better off.
00:11:29.451 --> 00:11:33.471
Focusing yourself at the issue the upstream issue of May, the herniated disc.
00:11:33.471 --> 00:11:42.291
So I think jumping into peripheral neuromodulatory techniques where you're scraping, poking needles, driving your hand, doing soft tissues.
00:11:42.740 --> 00:12:00.260
Now those might be part, even if you do understand that there's a proximal issue in the neck or the spine, that maybe you still use those techniques as a neuromodulatory thing, where again, we're putting it in a narrative where we're not fixing, people aren't faulty, we're just simply trying to decrease some of the sensitivity as their body does what bodies do, and that's, natural history recovery provided.
00:12:00.260 --> 00:12:01.400
We're not getting in the way of it.
00:12:01.660 --> 00:12:06.130
Next, using incorrect terminology, and this is one I've definitely been guilty with myself.
00:12:06.181 --> 00:12:08.010
so let's talk about what that terminology is.
00:12:08.100 --> 00:12:11.701
So, neuropathic pain is defined by the International Association for the Study of Pain.
00:12:12.041 --> 00:12:17.831
Neuropathic pain is pain that arises as a direct consequence of a lesion or diseases affecting the somatosensory system.
00:12:18.755 --> 00:12:33.811
So this is a helpful table that's been proposed, and this is a, again, coming out of Annina Schmid's work and her colleagues where this is something that I would immediately call everything a radiculopathy and not really understood those terms as I was applying them in my own practice.
00:12:34.150 --> 00:12:38.681
I work with a lot of osteopaths and they throw somatic referred pain, not pretty much majority of everything.
00:12:38.961 --> 00:12:43.701
I joke, of course, they're very good and they do some things, but the somatic referred thing gets thrown around quite a bit.
00:12:44.061 --> 00:12:45.051
So somatic referred.
00:12:45.355 --> 00:12:55.125
Pain really looks at the source of the pain being noxious stimulation of nerve endings in somatic structures, discs, facet joints or muscles, tendons, ligaments.
00:12:55.125 --> 00:12:58.775
And the pain is often a aching, gnawing pressure type pain.
00:12:59.046 --> 00:13:02.855
And it's referred it's not necessarily distributed in any specific.
00:13:03.321 --> 00:13:07.760
Anatomically plausible, neuropathic, or, nerve distribution, be it peripheral, be it nerve root.
00:13:07.760 --> 00:13:18.880
So it, but it's just this kinda general distribution in radiation and there's been plenty of studies that have shown facet distributions and distributions of discogenic pain when maybe possibly nerves aren't being affected.
00:13:18.941 --> 00:13:20.140
Of course, there's criticisms.
00:13:20.140 --> 00:13:23.051
Are we ever gonna be able to perfectly isolate a pain to a specific tissue?
00:13:23.051 --> 00:13:23.650
I get it.
00:13:23.961 --> 00:13:29.321
There are times where tissues can have the primary referring issue from and be maybe the primary.
00:13:29.706 --> 00:13:34.326
Target we need to be looking at as we're trying to help somebody with pain and then radicular pain.
00:13:34.326 --> 00:13:51.216
And I think radicular pain we often mistake is radiculopathy and radicular pain can be hyperexcitability and discharges of the dorsal horn or dorsal root ganglion caused by, inflammation, ischemia or mechanical deformation if radicular pain coexists with radiculopathy.
00:13:51.216 --> 00:13:53.135
So this can have a radiculopathy, but.
00:13:53.671 --> 00:13:57.030
If we go to the radiculopathy finding, this is with hard neurologic signs.
00:13:57.030 --> 00:14:02.561
We're seeing sensory loss, we're seeing myoma loss, we're seeing reflex loss.
00:14:02.561 --> 00:14:05.051
There's concrete hard neuro signs that accompany radiculopathy.
00:14:05.100 --> 00:14:12.390
You can have positive nerve testing, nerve sensitivity testing, be it neurodynamics, palpatory tests and all these different things in a radicular pain.
00:14:12.390 --> 00:14:18.030
But it's probably radicular if you're not seeing any significant hard neurologic signs in your neurologic examination.
00:14:18.311 --> 00:14:21.961
So we want to have a good neurologic exam that'll help us differentiate these.
00:14:21.961 --> 00:14:26.850
So again, being able to differentiate your terminology between somatic referred.
00:14:27.230 --> 00:14:29.120
Radicular pain and radiculopathy.
00:14:29.120 --> 00:14:37.821
And again, radicular pain and radiculopathy are often gonna be some of those things where we're thinking there's neuropathic pain involved and we can do some of those exam things that we spoke about earlier.
00:14:37.821 --> 00:14:37.850
I.
00:14:38.264 --> 00:14:41.684
And lastly, not testing small fiber dysfunction.
00:14:41.684 --> 00:14:51.225
So, and this is one that I've been guilty of, it wasn't until our podcast last week, and I'm gonna give you some check out the card I'll be able to direct you to that episode and it'll talk to some of the issues we have.
00:14:51.225 --> 00:14:58.394
And in that episode, it was more from whiplash associated Disorder type two, which was previously thought to be primarily a musculoskeletal only issue.
00:14:58.715 --> 00:15:02.174
And why, looking at small fiber dysfunction might be helpful for those folks.
00:15:02.514 --> 00:15:08.335
So one simple, one pin prick would be taking this super fancy piece of equipment, which is a paperclip.
00:15:08.335 --> 00:15:18.325
You got a dull side, you got a sharp side, and then you can just go down in nerve distributions and say, have a patient, maybe you have'em close their eyes so they ain't cheating, sharper, dull, sharper, dull, sharper, dull.
00:15:18.325 --> 00:15:21.485
And you're just having that patient go throughout that nerve root distribution.
00:15:22.259 --> 00:15:23.940
So that's a very fancy piece of equipment.
00:15:23.990 --> 00:15:25.730
And then lastly, you can have coins.
00:15:26.159 --> 00:15:34.620
And this is one a Nina had described in her work where we use a coin to determine if the person's got some thermal detection threshold issues.
00:15:34.620 --> 00:15:39.929
So you'd have one of these in your pocket that would ideally bring a coin up to body temperature.
00:15:40.259 --> 00:15:44.490
And then you'd have a coin that maybe is sitting out at room temperature, which would be cool or cold.
00:15:45.929 --> 00:15:54.480
So let's look at our fancy cold detection procedure and just gonna go over some of the procedures of that to help determine if there's some cold thermal difficulties.
00:15:54.480 --> 00:15:58.200
So we're gonna place the room temperature coin on the lateral arm.
00:15:58.200 --> 00:16:01.080
Remember, the room temperature coin is the one that should be perceived as cooler.
00:16:01.350 --> 00:16:06.090
We're gonna palpate it on the lateral arm, then we're gonna immediately place it on the Palmer tip of the index finger.
00:16:06.389 --> 00:16:10.529
And what we'll do with that is, does this feel the same, colder or warmer than your upper arm?
00:16:10.934 --> 00:16:18.014
And the interpretation of this is basically if the fingertip feels warmer or less cold, then this might be a possible cold detection deficit.
00:16:18.764 --> 00:16:28.095
Now if we look at a warm detection procedure, you may have guessed this, you're gonna grab the one outta your pocket, that's body temperature that should be warmed, and you're gonna place that warm coin on the lateral upper arm.
00:16:28.125 --> 00:16:32.115
Again, you could maybe do this in the thigh and then into the distal toes for somebody with lower extremity.
00:16:32.475 --> 00:16:38.475
Then you're gonna place it on the Palmer Index fingertip and ask the patient, does this feel the same, colder or warmer than your upper extremity?
00:16:38.524 --> 00:16:44.254
And the interpretation of this would be if the fingertip feels colder or less warm, possible warm detection deficit.
00:16:44.554 --> 00:16:47.125
So our clinical tip with this one would be, try not to use.
00:16:47.634 --> 00:16:50.455
Leading language or things that are, is it better?
00:16:50.455 --> 00:16:51.024
Is it worse?
00:16:51.024 --> 00:16:51.625
Is it colder?
00:16:51.625 --> 00:16:52.225
Is it warmer?
00:16:52.225 --> 00:16:54.654
You just let the patient, you give'em some choices and they choose.
00:16:54.654 --> 00:16:55.794
Versus you lead'em to a choice.
00:16:55.794 --> 00:16:56.455
Is this colder?
00:16:56.695 --> 00:16:57.414
Is this warmer?
00:16:57.664 --> 00:17:04.724
Because, and patients sometimes can be people pleasers and maybe give you answers you they think you want to hear versus maybe a more true objective thing.
00:17:05.115 --> 00:17:08.325
And remember too, the lateral upper arm just acts as a control site.
00:17:08.630 --> 00:17:25.354
It's less commonly affected with a neuropathy, so it's something that can be something that often we wouldn't expect to have neuropathy, but in the case where we might have a patient where we're thinking whatever reason or small fiber issue might be more than just, than the distal extremities, then obviously we'd want to try to find a different control site for that person.
00:17:25.521 --> 00:17:27.501
So hopefully this episode helped y'all.
00:17:27.531 --> 00:17:35.221
Again, if you're interested, make sure you download the clinical cheat sheet in the show notes, Or go to modern pain care.com/neuropathic and you can download it there.
00:17:35.491 --> 00:17:36.872
Hopefully it's helpful for you to the clinic.
00:17:37.082 --> 00:17:39.602
I'd also love to know if this episode was helpful for you.
00:17:39.602 --> 00:17:42.092
I want to try to create content that's helpful for you on the clinic.
00:17:42.432 --> 00:17:47.561
I know I've had questions from folks that I've mentored in the past about this, so hopefully it's valuable to you.
00:17:47.561 --> 00:17:50.172
Drop a comment in the comments below, let me know what you thought.
00:17:50.511 --> 00:17:55.551
And I'd love to hear if you could share some of your tips that you might have found in your work with folks with Neuropathic Pain.
00:17:55.912 --> 00:17:56.961
We're gonna leave it there this week.
00:17:56.961 --> 00:17:58.192
We'll talk to you all next week.
00:17:59.388 --> 00:18:03.378
This has been another episode of The Modern Pain Podcast with Dr.
00:18:03.378 --> 00:18:04.318
Mark Kargela.
00:18:04.338 --> 00:18:08.509
Join us next time as we continue our journey to help change the story around pain.
00:18:08.509 --> 00:18:12.108
For more information on the show, visit modern pain care.com.
00:18:12.169 --> 00:18:15.259
This podcast is for educational and informational purposes only.
00:18:15.259 --> 00:18:17.628
It is not a substitute for medical advice or treatment.
00:18:17.634 --> 00:18:22.848
Please consult a licensed professional for your specific medical needs, changing the story around pain.
00:18:23.028 --> 00:18:25.368
This is the Modern Pain Podcast.
00:00:00.143 --> 00:00:03.713
00:00:03.983 --> 00:00:08.034
00:00:08.333 --> 00:00:12.114
00:00:12.114 --> 00:00:15.054
00:00:15.954 --> 00:00:17.333
00:00:17.454 --> 00:00:22.344
00:00:22.853 --> 00:00:24.954
00:00:24.954 --> 00:00:30.294
00:00:31.103 --> 00:00:31.794
00:00:31.794 --> 00:00:33.444
00:00:34.359 --> 00:00:40.209
00:00:40.509 --> 00:00:51.488
00:00:52.298 --> 00:00:57.399
00:00:57.819 --> 00:01:04.328
00:01:04.899 --> 00:01:12.998
00:01:13.569 --> 00:01:19.269
00:01:19.968 --> 00:01:21.287
00:01:21.721 --> 00:01:25.561
00:01:26.495 --> 00:01:29.766
00:01:29.766 --> 00:01:32.615
00:01:32.615 --> 00:01:33.906
00:01:33.906 --> 00:01:44.301
00:01:44.301 --> 00:01:46.415
00:01:46.835 --> 00:01:53.195
00:01:53.195 --> 00:01:57.486
00:01:58.146 --> 00:02:03.195
00:02:03.376 --> 00:02:09.885
00:02:10.336 --> 00:02:19.306
00:02:19.980 --> 00:02:23.251
00:02:23.251 --> 00:02:34.290
00:02:34.290 --> 00:02:34.350
00:02:35.656 --> 00:02:40.906
00:02:41.135 --> 00:02:49.906
00:02:50.506 --> 00:03:05.725
00:03:06.746 --> 00:03:10.406
00:03:10.406 --> 00:03:23.545
00:03:23.846 --> 00:03:30.295
00:03:30.295 --> 00:03:31.735
00:03:31.735 --> 00:03:35.066
00:03:35.161 --> 00:03:41.431
00:03:41.431 --> 00:03:45.811
00:03:46.080 --> 00:03:49.980
00:03:50.550 --> 00:03:56.401
00:03:56.640 --> 00:04:09.181
00:04:09.681 --> 00:04:12.860
00:04:12.860 --> 00:04:20.120
00:04:20.886 --> 00:04:28.656
00:04:29.026 --> 00:04:33.466
00:04:33.466 --> 00:04:34.456
00:04:34.815 --> 00:04:41.776
00:04:43.276 --> 00:04:49.365
00:04:55.935 --> 00:05:04.245
00:05:04.245 --> 00:05:11.235
00:05:11.730 --> 00:05:34.300
00:05:34.300 --> 00:05:40.511
00:05:41.036 --> 00:05:42.925
00:05:42.975 --> 00:05:47.475
00:05:48.136 --> 00:05:57.975
00:05:57.975 --> 00:06:05.386
00:06:05.685 --> 00:06:07.966
00:06:08.690 --> 00:06:11.901
00:06:12.350 --> 00:06:26.110
00:06:26.331 --> 00:06:42.891
00:06:42.891 --> 00:06:49.101
00:06:49.442 --> 00:06:56.572
00:06:56.572 --> 00:07:16.781
00:07:17.271 --> 00:07:28.851
00:07:29.122 --> 00:07:32.692
00:07:32.692 --> 00:07:33.682
00:07:33.682 --> 00:07:35.182
00:07:35.182 --> 00:07:39.023
00:07:39.233 --> 00:07:40.103
00:07:40.283 --> 00:07:42.692
00:07:42.963 --> 00:07:43.952
00:07:43.952 --> 00:07:45.182
00:07:45.598 --> 00:07:48.778
00:07:49.228 --> 00:07:51.987
00:07:51.987 --> 00:07:58.408
00:07:58.408 --> 00:08:00.088
00:08:00.117 --> 00:08:09.348
00:08:09.348 --> 00:08:10.968
00:08:10.968 --> 00:08:14.358
00:08:14.687 --> 00:08:17.358
00:08:17.358 --> 00:08:24.617
00:08:24.617 --> 00:08:27.468
00:08:28.043 --> 00:08:33.543
00:08:33.543 --> 00:08:37.023
00:08:37.322 --> 00:08:48.123
00:08:48.852 --> 00:08:51.552
00:08:51.552 --> 00:08:53.592
00:08:53.592 --> 00:08:58.033
00:08:58.033 --> 00:08:59.413
00:08:59.413 --> 00:09:02.423
00:09:02.423 --> 00:09:10.793
00:09:10.793 --> 00:09:14.062
00:09:14.186 --> 00:09:17.995
00:09:17.995 --> 00:09:25.105
00:09:25.105 --> 00:09:29.975
00:09:29.975 --> 00:09:35.206
00:09:35.456 --> 00:09:41.765
00:09:41.765 --> 00:09:41.826
00:09:42.676 --> 00:09:46.576
00:09:46.576 --> 00:09:54.466
00:09:54.466 --> 00:09:58.666
00:09:58.666 --> 00:10:03.696
00:10:03.946 --> 00:10:10.515
00:10:10.791 --> 00:10:12.110
00:10:12.110 --> 00:10:14.630
00:10:14.971 --> 00:10:26.280
00:10:26.280 --> 00:10:28.260
00:10:28.291 --> 00:10:30.150
00:10:30.421 --> 00:10:31.951
00:10:31.951 --> 00:10:34.620
00:10:34.900 --> 00:10:43.931
00:10:43.931 --> 00:10:46.030
00:10:46.721 --> 00:10:49.860
00:10:50.910 --> 00:11:05.331
00:11:05.331 --> 00:11:16.041
00:11:16.566 --> 00:11:23.255
00:11:23.255 --> 00:11:26.826
00:11:27.365 --> 00:11:28.985
00:11:29.451 --> 00:11:33.471
00:11:33.471 --> 00:11:42.291
00:11:42.740 --> 00:12:00.260
00:12:00.260 --> 00:12:01.400
00:12:01.660 --> 00:12:06.130
00:12:06.181 --> 00:12:08.010
00:12:08.100 --> 00:12:11.701
00:12:12.041 --> 00:12:17.831
00:12:18.755 --> 00:12:33.811
00:12:34.150 --> 00:12:38.681
00:12:38.961 --> 00:12:43.701
00:12:44.061 --> 00:12:45.051
00:12:45.355 --> 00:12:55.125
00:12:55.125 --> 00:12:58.775
00:12:59.046 --> 00:13:02.855
00:13:03.321 --> 00:13:07.760
00:13:07.760 --> 00:13:18.880
00:13:18.941 --> 00:13:20.140
00:13:20.140 --> 00:13:23.051
00:13:23.051 --> 00:13:23.650
00:13:23.961 --> 00:13:29.321
00:13:29.706 --> 00:13:34.326
00:13:34.326 --> 00:13:51.216
00:13:51.216 --> 00:13:53.135
00:13:53.671 --> 00:13:57.030
00:13:57.030 --> 00:14:02.561
00:14:02.561 --> 00:14:05.051
00:14:05.100 --> 00:14:12.390
00:14:12.390 --> 00:14:18.030
00:14:18.311 --> 00:14:21.961
00:14:21.961 --> 00:14:26.850
00:14:27.230 --> 00:14:29.120
00:14:29.120 --> 00:14:37.821
00:14:37.821 --> 00:14:37.850
00:14:38.264 --> 00:14:41.684
00:14:41.684 --> 00:14:51.225
00:14:51.225 --> 00:14:58.394
00:14:58.715 --> 00:15:02.174
00:15:02.514 --> 00:15:08.335
00:15:08.335 --> 00:15:18.325
00:15:18.325 --> 00:15:21.485
00:15:22.259 --> 00:15:23.940
00:15:23.990 --> 00:15:25.730
00:15:26.159 --> 00:15:34.620
00:15:34.620 --> 00:15:39.929
00:15:40.259 --> 00:15:44.490
00:15:45.929 --> 00:15:54.480
00:15:54.480 --> 00:15:58.200
00:15:58.200 --> 00:16:01.080
00:16:01.350 --> 00:16:06.090
00:16:06.389 --> 00:16:10.529
00:16:10.934 --> 00:16:18.014
00:16:18.764 --> 00:16:28.095
00:16:28.125 --> 00:16:32.115
00:16:32.475 --> 00:16:38.475
00:16:38.524 --> 00:16:44.254
00:16:44.554 --> 00:16:47.125
00:16:47.634 --> 00:16:50.455
00:16:50.455 --> 00:16:51.024
00:16:51.024 --> 00:16:51.625
00:16:51.625 --> 00:16:52.225
00:16:52.225 --> 00:16:54.654
00:16:54.654 --> 00:16:55.794
00:16:55.794 --> 00:16:56.455
00:16:56.695 --> 00:16:57.414
00:16:57.664 --> 00:17:04.724
00:17:05.115 --> 00:17:08.325
00:17:08.630 --> 00:17:25.354
00:17:25.521 --> 00:17:27.501
00:17:27.531 --> 00:17:35.221
00:17:35.491 --> 00:17:36.872
00:17:37.082 --> 00:17:39.602
00:17:39.602 --> 00:17:42.092
00:17:42.432 --> 00:17:47.561
00:17:47.561 --> 00:17:50.172
00:17:50.511 --> 00:17:55.551
00:17:55.912 --> 00:17:56.961
00:17:56.961 --> 00:17:58.192
00:17:59.388 --> 00:18:03.378
00:18:03.378 --> 00:18:04.318
00:18:04.338 --> 00:18:08.509
00:18:08.509 --> 00:18:12.108
00:18:12.169 --> 00:18:15.259
00:18:15.259 --> 00:18:17.628
00:18:17.634 --> 00:18:22.848
00:18:23.028 --> 00:18:25.368
