Event 1: Initial Injury

Mr. Lane, a middle aged man with his right arm in a compression sleeve
Mr. Lane

This case presentation follows a 43-year-old farmer named Mr. Lane who injured his right arm after it got stuck in a combine. He was then air lifted to a tertiary care center. The case includes Mr. Lane's initial injury, acute pain, and the development of chronic pain and acute on chronic pain.

You'll follow Mr. Lane for approximately a year and cover eight events in his health care journey. The case emphasizes issues regarding family, culture of a farmer, financial concerns, psychosocial issues related to pain, integrating care in a local and tertiary health care environment and overall difficulty with pain control.


There are four instruments that you need to familiarize yourself with in this module to rate pain.

  1. NRS is a numeric rating scale for pain from zero to ten where 0 is no pain and 10 is worst pain imaginable.
  2. Quick Dash is a shortened version of the disabilities of the arm, shoulder and hand measure. It is a questionnaire about function for the arm.
  3. FPS or functional pain scale is a questionnaire that asks about pain during functional activities. It has a score of zero: no pain, to 5: is pain intolerable with all activities.
  4. Opioid risk tool or ORT is a tool to determine the possible risk for addiction prior to prescribing an opioid in pain management.

Click the "Rating Pain" tab to learn more about each instrument.

Event Timeline

Mr. Lane experiences his initial right arm crush injury on October 8th, 2013 with resultant right arm chronic pain. He further suffers 2 acute on chronic pain events: a skin graft on December 4th, 2013, and cubital tunnel decompression on June 1, 2014. The events are numbered 1 to 8 to help you with the timeline of events as you work through the module.

Click through the buttons at the top of the page to begin the module and review each event listed below in more detail.

  • Event #1: 10/8/2013. Initial injury right upper extremity (RUE) and decompression surgery.
  • Event #2: 12/4/2013. Skin graft (RUE).
  • Event #3: 1/4/2014. Initial visit with physical therapy (PT) and occupational therapy (OT) for RUE.
  • Event #4: 1/15/2014. Pain clinic referral.
  • Event #5: 2/1/2014. Referral to outpatient counseling.
  • Event #6: 4/1/2014. Return to work part time.
  • Event #7: 6/1/2014. Right cubital tunnel decompression.
  • Event #8: 7/1/2014. Resume physical therapy.
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