Why Would You Not Use the Sternal Rub as a Pain Stimulus

The sternal rub should not be used as a pain stimulus because it can cause discomfort and distress to the patient. It is an invasive procedure that involves rubbing the sternum, which is a sensitive area. Additionally, it can trigger the gag reflex, which can be unpleasant for the patient. There are other, less invasive methods of assessing pain, such as the visual analog scale or the numeric rating scale, which are more comfortable for the patient and provide more accurate results.

Difficulty in Interpretation

The sternal rub, a pain stimulus commonly used in clinical settings, can be challenging to interpret due to several reasons:

  • Subjectivity: The intensity of the perceived pain varies significantly among individuals, making it difficult to assess the severity of pain objectively.
  • Cultural Influences: Cultural norms and expectations can influence how individuals express and perceive pain, affecting the accuracy of the sternal rub assessment.
  • Cognitive Factors: Cognitive factors, such as anxiety, fear, and expectations, can also influence the perceived intensity of pain, making it difficult to distinguish between genuine pain and perceived pain.
  • Conditioning: Repeated exposure to the sternal rub as a pain stimulus can lead to conditioning, where the stimulus becomes associated with pain, even in the absence of actual pain.
  • Variable Response: Different individuals may respond differently to the sternal rub, with some exhibiting strong reactions and others showing little response, making it difficult to compare pain levels across individuals.

Due to these difficulties, the sternal rub is not an ideal pain assessment tool for all patients, especially in situations where accurate and objective pain assessment is crucial.

Potential for Misdiagnosis

The sternal rub is a painful stimulus that can cause patients to withdraw or cry out in pain. However, this response can also be seen in patients with other conditions, such as:

  • meningitis
  • sepsis
  • intracranial hemorrhage

Therefore, using the sternal rub as a pain stimulus can potentially lead to a misdiagnosis of these conditions.

Patient Discomfort

The sternal rub is a painful stimulus that can cause significant discomfort to the patient. This discomfort can lead to anxiety, resistance, and a reluctance to cooperate with the examination or procedure. In some cases, the discomfort can be so severe that it can make it difficult for the patient to complete the examination or procedure.

There are a number of reasons why a sternal rub should not be used as a pain stimulus. First, it is simply not necessary. There are a number of other less painful stimuli that can be used to elicit a response from the patient. These include applying pressure to the nail bed, pinching the skin, or pricking the skin with a needle.

Second, the sternal rub can cause tissue damage. The sternum is a thin bone that is covered by a thin layer of skin. Rubbing the sternum can cause irritation, inflammation, and even bruising. In some cases, the sternal rub can even cause the sternum to fracture.

Third, the sternal rub can trigger a vagal response. The vagal response is a reflex that occurs when the vagus nerve is stimulated. This reflex can cause a number of symptoms, including nausea, vomiting, and fainting. In some cases, the vagal response can be so severe that it can lead to death.

Alternatives to the Sternal Rub

  • Apply pressure to the nail bed
  • Pinch the skin
  • Prick the skin with a needle
  • Use a cold pack
  • Use a heat pack
  • Use a transcutaneous electrical nerve stimulator (TENS)

Table of Pain Stimuli

StimulusPain LevelDiscomfortTissue DamageVagal Response
Sternal rubHighHighHighHigh
Nail bed pressureLowLowLowLow
Skin pinchingMediumMediumLowLow
Skin prickHighMediumLowLow
Cold packLowLowLowLow
Heat packLowLowLowLow