The primary complaint must be explored in detail by the clinician with first aid training to discover the evolution of symptoms, including the location, onset, severity, frequency, duration, and limitations caused by the pain or disability. The individual’s pain perception can indicate which structures may be injured. There are two categories of pain: somatic, and visceral.
Somatic pain arises from the skin, ligaments, muscles, bones, and joints and is the most common type of pain encountered in musculoskeletal injuries. It is classified into two major types: deep, and superficial. Deep somatic pain is described as diffuse or nagging, as if intense pressure is being exerted on the structures, and may be complicated by stabbing pain. Deep somatic pain is longer lasting and usually indicates significant tissue damage to bone, internal joint structures, or muscles. Superficial somatic pain results from injury to the epidermis or dermis and usually is a sharp, prickly type of pain that tends to be brief.
Visceral pain results from disease or injury to an organ in the thoracic or abdominal cavity, such as compression, tension, or distention of the viscera. Similar to deep somatic pain, it is perceived as deeply located, nagging, and pressing, and it often is accompanied by nausea and vomiting. Referred pain is a type of visceral pain that travels along the same nerve pathways as somatic pain. It is perceived by the brain as being somatic in origin. In other words, the injury is in one region, but the brain considers it in another. For example, referred pain occurs when an individual has a heart attack and feels pain in the chest, left arm, and sometimes, the neck.
Pain can travel up or down the length of any nerve and be referred to another region. An individual with a low back problem may feel the pain down the gluteal region and into the back of the leg. If a nerve is injured, pain or a change in sensation, such as a numbing or burning sensation, can be felt along the length of the nerve.
In assessing the injury, the examiner should ask detailed questions about the location, onset, nature, severity, frequency, and duration of the pain. For example, the following questions should be asked: Where is the pain? Can you point to a specific painful spot? Is the pain limited to that area, or does it radiate into other parts of the leg or foot? How bad is the pain on a scale from 1 to 10, with 10 being most severe? Can you describe the pain (e.g., dull, sharp, or aching)? In chronic conditions, the following questions should be asked: When does the pain begin (e.g., when you get out of bed, while sitting, while walking, during exercise, or at night)? How long does the pain last? Is the pain worse before, during, or after activity? What activities aggravate or alleviate the symptoms? Does the pain wake you up at night? How long has the condition been present? Has the pain changed or stayed the same? In the past, what medications, treatments, or exercise programs have improved the situation?
If pain is localized, it suggests that limited bony or soft-tissue structures may be involved. Diffuse pain around the entire joint may indicate inflammation of the joint capsule or injury to several structures. If pain radiates into other areas of the limb or body, it may be traveling up or down the length of a nerve. These responses also can determine if the condition is disabling enough to require referral to a physician.