Pain Management Tools

Assessment

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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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7.

 

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