pain management tools. assessment 3 pain diagram
TRANSCRIPT
Pain Management Tools
Assessment
3
Pain Diagram
The information presented here is taken entirely, without any content modification from: Kendall, N A S, Linton, S J & Main, C J (1997). Guide to Assessing Psycho-social Yellow Flags in Acute Low Back Pain: Risk Factors for
Long-Term Disability and Work Loss. Accident Compensation Corporation and the New Zealand Guidelines Group, Wellington, New Zealand. (Oct, 2004 Edition).
Suggested steps to better early
behavioral management of low back pain
problems
Psychosocial Yellow Flags:Helping Someone at Risk
Red Flags Possible fracture
Possible tumour or infection Possible significant neurological deficit
From history
• Major trauma • Minor trauma in elderly or osteoporotic
• Age >50 or <20 years • History of cancer • Constitutional symptoms (fever, chills, weight loss) • Recent bacterial infection • IV drug use • Immunosuppression • Pain worsening at night or when supine
• Severe or progressive sensory alteration or weakness • Bladder or bowel dysfunction
From physical examination • Evidence of neurological deficit (in legs or perineum in the case of low back pain)
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PHQ-9
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GAD-7
Pain Catastrophizing Scale
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RATING 0 1 2 3 4
MEANING Not at all To a slight To a moderate To a great All the degree degree degree time
Statement Rating
1 I worry all the time about whether the pain will end
2 I feel I can’t go on
3 It’s terrible and I think it’s never going to get any better
4 It’s awful and I feel that it overwhelms me.
5 I feel I can’t stand it anymore
6 I become afraid that the pain will get worse.
7 I keep thinking of other painful events
8 I anxiously want the pain to go away
9 I can’t seem to keep it out of my mind
10 I keep thinking about how much it hurts
11 I keep thinking about how badly I want the pain to stop
12 There’s nothing I can do to reduce the intensity of the pain
13 I wonder whether something serious may happen
The Pain Catastrophizing Scale: Development and Validation, Michael J. L. Sullivan, Scott R. Bishop and Jayne Pivik, Psychological Assessment, 1995, Vol. 7, No. 4, 524-532
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DN4
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Goals Decided with Patient:
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Initiation Checklist
Are opioids indicated for this pain conditionExplained potential benefits
Explained adverse effects
Explained risks
Patient given information sheet
Signed treatment agreement (as needed)
Urine drug screening (as needed)
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Osteoarthritis Rheumatoid arthritis Neuropathic pain Mixed nociceptive and neuropathic states
Limited evidence or no efficacy in: Fibromyalgia Headache disorders
Conditions Opioids Have Efficacy In:
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Algorithm