Pain EvaluationsPain Evaluations

Candace Barnacal, Kristen Candace Barnacal, Kristen Dmytruk, Heather Lowe, Krista Dmytruk, Heather Lowe, Krista Mills, Victoria Morris, Beth Pyle, Mills, Victoria Morris, Beth Pyle,

Emily RodriguesEmily Rodrigues

What is Pain?What is Pain?

““Pain is a subjective experience that is generated Pain is a subjective experience that is generated by widespread, parallel neural networks in the by widespread, parallel neural networks in the brain on the basis of multiple inputs from brain on the basis of multiple inputs from sensory systems, as well as, from brain areas sensory systems, as well as, from brain areas that underlie past experience, attention, that underlie past experience, attention, evaluation, and meaning. Humans are evaluation, and meaning. Humans are fortunate to have language to express their fortunate to have language to express their pain.”pain.”

- Ronald Melzack- Ronald Melzack(designed the McGill (designed the McGill Pain Questionnaire)Pain Questionnaire)

Why Have Pain Evaluations?Why Have Pain Evaluations?

►These tests are easy to administer These tests are easy to administer becuase they can be downloaded off becuase they can be downloaded off the internet and most of them can be the internet and most of them can be performed with out the help of a performed with out the help of a professionalprofessional

►These tests assess the type, quantity, These tests assess the type, quantity, intensity, and quality of an individuals intensity, and quality of an individuals pain to determine if they need pain to determine if they need surgery, a leave of absence from work, surgery, a leave of absence from work, or an ergonomic evaluationor an ergonomic evaluation

Pain DrawingsPain Drawings

►Originally designed for patients with low Originally designed for patients with low back pain (lumbar) or patients being back pain (lumbar) or patients being considered for surgeryconsidered for surgery

►Allows rapid assessment of subjective Allows rapid assessment of subjective painpain

►Can assess similar patterns of pain Can assess similar patterns of pain through out the bodythrough out the body

►Get a better understanding of what kind Get a better understanding of what kind of pain the patient is feeling and where of pain the patient is feeling and where they are feeling itthey are feeling it

Pain Drawings cont’dPain Drawings cont’d

► It includes two diagrams of the human body:It includes two diagrams of the human body: one is anterior and the other posteriorone is anterior and the other posterior

► Four different descriptors are given a Four different descriptors are given a specific symbol:specific symbol:

=== is for numbness=== is for numbnessOOO is for pins and needlesOOO is for pins and needlesXXX is for burning painXXX is for burning pain///// is for stabbing pain///// is for stabbing pain► Patients place these symbols on the areas of Patients place these symbols on the areas of

the body where they are feeling themthe body where they are feeling them

Pain Drawings cont’dPain Drawings cont’d

►After the patient has filled out the After the patient has filled out the form it is evaluated together by the form it is evaluated together by the patient and the practitioner and then patient and the practitioner and then the origins of pain are found on the the origins of pain are found on the patients body and discussed furtherpatients body and discussed further

McGill Pain QuestionnaireMcGill Pain Questionnaire

►Originally designed by Ronald Melzack Originally designed by Ronald Melzack in the 1970’sin the 1970’s

►Used to determine the intensity and Used to determine the intensity and type of people’s pain, as well as, type of people’s pain, as well as, indicate the extent of change in pain indicate the extent of change in pain quality and intensity after an quality and intensity after an intervention (rehab)intervention (rehab)

►Melzack wanted to design a tool that Melzack wanted to design a tool that was easy to use and that was reliablewas easy to use and that was reliable

MPQ cont’dMPQ cont’d

►The MPQ takes 5-10 minutes to administerThe MPQ takes 5-10 minutes to administer► It consists of a list of word descriptors, It consists of a list of word descriptors,

which are usually put into three categories: which are usually put into three categories: sensory (i.e. throbbing or burning), sensory (i.e. throbbing or burning), affective (i.e. exhausting or punishing), affective (i.e. exhausting or punishing), and evaluative (i.e. annoying or intense)and evaluative (i.e. annoying or intense)

►Each descriptor is given a rank and the Each descriptor is given a rank and the sum of these ranks produces the pain sum of these ranks produces the pain rating index (PRI)rating index (PRI)

MPQ cont’dMPQ cont’d

► There is also a present pain intensity (PPI) There is also a present pain intensity (PPI) that is based on a scale of 0-5that is based on a scale of 0-5

► The number of words chosen to describe The number of words chosen to describe their pain is also taken into considerationtheir pain is also taken into consideration

► The patient can write down if their pain is The patient can write down if their pain is external or internal plus any additional external or internal plus any additional commentscomments

► There is also a short form of this There is also a short form of this questionnaire, which can be modified to fit questionnaire, which can be modified to fit individual needs i.e. answering for a specific individual needs i.e. answering for a specific part of the body, such as the pelvispart of the body, such as the pelvis

To the left is the original MPQ and to the right is a short version that has been modified

Visual Analogue ScaleVisual Analogue Scale

►This test is very simple and quick to This test is very simple and quick to administeradminister

► It measures a characteristic or attitude It measures a characteristic or attitude that is believed to range across a that is believed to range across a continuum – in this case it is paincontinuum – in this case it is pain

►Since a patient’s pain can range from Since a patient’s pain can range from mild to severe and can change from mild to severe and can change from day to day this tool is helpful to day to day this tool is helpful to determine a pattern in that changedetermine a pattern in that change

VAS cont’dVAS cont’d

► A VAS consists of a line that is 100mm in length A VAS consists of a line that is 100mm in length and at one end there is a description such as and at one end there is a description such as ‘No Pain’ and at the other end ‘Severe Pain’‘No Pain’ and at the other end ‘Severe Pain’

► The patient is then asked to mark on the line The patient is then asked to mark on the line where they feel would best represent their where they feel would best represent their current paincurrent pain

► The score is determined by measuring in mm The score is determined by measuring in mm from the left end of the line to the point where from the left end of the line to the point where the patient markedthe patient marked

VAS cont’dVAS cont’d

► A lot of pain evaluations use discrete categorizations A lot of pain evaluations use discrete categorizations of pain such as; none, mild, moderate, or severeof pain such as; none, mild, moderate, or severe

► However, most people’s pain does not jump from However, most people’s pain does not jump from one category to the next, instead most patients feel one category to the next, instead most patients feel their pain is continuous which is why having a their pain is continuous which is why having a continuum to rate pain allows for more accurate continuum to rate pain allows for more accurate resultsresults

► Other ways in which the VAS have been represented Other ways in which the VAS have been represented are by using vertical lines and extra descriptors are by using vertical lines and extra descriptors

► However, practitioners prefer to use scales that However, practitioners prefer to use scales that involve ranks (i.e. MPQ) because the VAS requires involve ranks (i.e. MPQ) because the VAS requires some interpretation by the practitioner which may some interpretation by the practitioner which may be inaccuratebe inaccurate

Pain Rating ScalePain Rating Scale

► There are many modifications to this testThere are many modifications to this test► Consists of making a scale, such as 0-10 with 0 Consists of making a scale, such as 0-10 with 0

being no pain and 10 being the worst pain everbeing no pain and 10 being the worst pain ever► To help patients quantify their pain the practitioner To help patients quantify their pain the practitioner

can ask them to think of the worst pain they’ve can ask them to think of the worst pain they’ve ever been in and compare the present pain to thatever been in and compare the present pain to that

► Also, the patient should be asked if the pain rating Also, the patient should be asked if the pain rating changes with activity or certain movementschanges with activity or certain movements

► To function well, patients need to have a rating of To function well, patients need to have a rating of 3 or less; ideally the patient should remain at a 2 3 or less; ideally the patient should remain at a 2 as much as possibleas much as possible

Pain Rating Scale cont’dPain Rating Scale cont’d

►The purpose of this test is so the The purpose of this test is so the practitioner can better understand the practitioner can better understand the patient’s level of pain and together patient’s level of pain and together they can set goals for pain reliefthey can set goals for pain relief

Dallas Pain QuestionnaireDallas Pain Questionnaire

► The DPQ was developed to assess the The DPQ was developed to assess the amount of chronic spinal pain that affects amount of chronic spinal pain that affects daily and work activities, leisure activities, daily and work activities, leisure activities, anxiety/depression, and social interestsanxiety/depression, and social interests

► It consists of a 16 item self-report that takes It consists of a 16 item self-report that takes about 5 minutes to completeabout 5 minutes to complete

► Each item contains its own scale, which are Each item contains its own scale, which are divided into 5-8 small segments and the divided into 5-8 small segments and the patient is asked to place an X to indicate patient is asked to place an X to indicate where their pain falls on that scalewhere their pain falls on that scale

DPQ cont’dDPQ cont’d

►On the left side of the scale is a descriptor (i.e. On the left side of the scale is a descriptor (i.e. no pain) and the value 0% and on the right side no pain) and the value 0% and on the right side there is another descriptor (i.e. pain all the there is another descriptor (i.e. pain all the time) and the value 100%time) and the value 100%

► This test allows the patient to measure pain on This test allows the patient to measure pain on a continuum, which can also track changes in a continuum, which can also track changes in painpain

► Also, this questionnaire looks at the social Also, this questionnaire looks at the social factors of pain, such as how the individual’s factors of pain, such as how the individual’s pain affects relationships with others, as well pain affects relationships with others, as well as, controlling emotions and any anxiety or as, controlling emotions and any anxiety or depression that may be caused by the paindepression that may be caused by the pain

DPQ cont’dDPQ cont’d

►This test is unique because it takes This test is unique because it takes into account social and emotional into account social and emotional factors related to painfactors related to pain

►Once these factors are determined the Once these factors are determined the proper intervention strategies can be proper intervention strategies can be takentaken

Alternate TestsAlternate Tests

►The Brief Pain Inventory consists of The Brief Pain Inventory consists of 9 questions with scales of 0-109 questions with scales of 0-10 A diagram so the patient can shade in A diagram so the patient can shade in

areas of pain and place an X on areas of areas of pain and place an X on areas of most painmost pain

Questions ask about past, current, worst, Questions ask about past, current, worst, and average pain, any treatment received and average pain, any treatment received for past pain, medication, as well as how for past pain, medication, as well as how much pain interferes with daily livingmuch pain interferes with daily living

Alternate Tests cont’dAlternate Tests cont’d

► The Standardized Nordic Questionnaire The Standardized Nordic Questionnaire (SNQ) is designed for workers exposed to (SNQ) is designed for workers exposed to arm and hand vibrations (such as a arm and hand vibrations (such as a chainsaw operator)chainsaw operator)

► Prolonged exposure to arm-hand vibration Prolonged exposure to arm-hand vibration can cause musculoskeletal disorders in the can cause musculoskeletal disorders in the corresponding areas, such as weakness, corresponding areas, such as weakness, pain or numbnesspain or numbness

► This test was developed by a team of Nordic This test was developed by a team of Nordic researchersresearchers

SNQ cont’dSNQ cont’d

►The researchers created the SNQ so The researchers created the SNQ so there was a simple standardized test there was a simple standardized test available to screen musculoskeletal available to screen musculoskeletal disorders, which could be used by disorders, which could be used by companies who are hiring people who companies who are hiring people who might be subject to arm-hand might be subject to arm-hand vibrations or those who have injuries vibrations or those who have injuries and need to be assessed for any and need to be assessed for any musculoskeletal disordersmusculoskeletal disorders

SNQ cont’dSNQ cont’d

► The questionnaire consists of nine questions The questionnaire consists of nine questions asking about any past or present pain or asking about any past or present pain or numbness in the body especially in the hands numbness in the body especially in the hands and feet, when in the year pain is most severe and feet, when in the year pain is most severe (spring, summer, fall, winter?), intensity of (spring, summer, fall, winter?), intensity of pain, how often pain occurs during the pain, how often pain occurs during the day/weekday/week

► There are diagrams for the person to shade in There are diagrams for the person to shade in the areas of most painthe areas of most pain

► Once the form is completed it is evaluated by Once the form is completed it is evaluated by a practitioner and the appropriate intervention a practitioner and the appropriate intervention strategies are takenstrategies are taken

Ergonomic ApplicationErgonomic Application

► Jobs in a factory, or grocery store that may Jobs in a factory, or grocery store that may involve a lot of heavy lifting, pulling, pushing, or involve a lot of heavy lifting, pulling, pushing, or repetitive movements may cause pain or injury repetitive movements may cause pain or injury to an employeeto an employee

► These tests can be use to assess an individual’s These tests can be use to assess an individual’s pain level and then treatment/rehab can be pain level and then treatment/rehab can be performed, or an ergonomic assessment of the performed, or an ergonomic assessment of the workplace can be done to determine if changes workplace can be done to determine if changes in the work environment or procedures need to in the work environment or procedures need to be changed or improvedbe changed or improved

► An ergonomic assessment can also get the An ergonomic assessment can also get the approval for workers compensation and money approval for workers compensation and money grants for new equipmentgrants for new equipment

Final ThoughtsFinal Thoughts

► Since these tests use subjective assessment Since these tests use subjective assessment the practitioner has to rely on the the practitioner has to rely on the individuals perception of their pain for an individuals perception of their pain for an accurate diagnosis and treatmentaccurate diagnosis and treatment

► Since everyone has a different tolerance of Since everyone has a different tolerance of pain, the patient may provide exaggerated pain, the patient may provide exaggerated or understated reports of painor understated reports of pain

►However, these tests are very easy to However, these tests are very easy to administer and evaluate, they are quick, and administer and evaluate, they are quick, and can be modified to fit individual needscan be modified to fit individual needs

The EndThe End