Evaluation of chronic non-cancer pain: Components and screening tools

History and physical examination
Identify possible pain etiology
Identify comorbidities that may affect treatment options
Examine for allodynia and/or sensory changes in painful body part
For patients who use opioids or patients with risk factors for opioid misuse or use disorder: Check PDMP Screen for opioid risk with ORT, SOAPP, COMM, or similar
Body diagram
Useful for all patients
For patients with multisite pain, screen for chronic widespread pain disorders with Widespread Pain Index and Symptom Severity Score
Pain history
OLDCARTS
Onset ("When did your pain start?")
Location ("Where does it hurt?")
Duration ("How long does your pain last?")
Character ("How does your pain feel?", ie, aching, burning, shooting, tingling)
Alleviating/Aggravating ("What makes your pain better/worse?") and Attribution ("What do you think is the cause?")
Radiation ("Does this pain spread anywhere else?")
Temporal pattern ("Does your pain vary over the course of a day?")
Symptoms associated ("How does your pain impact your physical function, your mood, your sleep?")
Pain severity and impact
Pain intensity, pain interference with enjoyment of life and general function (PEG)
What number (0 to 10) best describes your pain on average in the past week?						________________
What number (0 to 10) best describes how, in the past week, pain has interfered with your enjoyment of life?						________________
What number (0 to 10) best describes how, in the past week, pain has interfered with your general function?						________________
Mood assessment
PHQ-4^[1]
Over the past 2 weeks, have you been bothered by these problems?			Not at all	Several days	More days than not	Nearly every day
Feeling nervous, anxious, or on edge			0	1	2	3
Not being able to stop or control worrying			0	1	2	3
Feeling down, depressed, or hopeless			0	1	2	3
Little interest or pleasure in doing things			0	1	2	3
Scoring: Add total score For score >5, screen for anxiety, depression, and post-traumatic stress, with GAD-7, PHQ-9, and PTSD-5
Sleep assessment
Sleep initiation and maintenance
Does pain interfere with falling asleep?
Does pain interfere with staying asleep?
Screen for obstructive sleep apnea – STOP-Bang^[2,3]
Yes	No	Snore – Do you snore loudly (loud enough to be heard through closed doors, or your bed partner elbows you for snoring at night)?
Yes	No	Tired – Do you often feel tired, fatigued, or sleepy during the day?
Yes	No	Observed – Has anyone observed you stop breathing or choking/gasping during sleep?
Yes	No	Pressure – Do you have or are you being treated for high blood pressure?
Yes	No	Body mass index >35 kg/m²?
Yes	No	Age older than 50 years?
Yes	No	Neck size large (male: ≥17 inches, female: ≥16 inches)?
Yes	No	Gender = male?
Scoring: Low risk of OSA: Yes to 0 to 2 questions Intermediate risk of OSA: Yes to 3 to 4 questions High risk of OSA: Yes to ≥5 questions

PDMP: prescription drug monitoring programs; ORT: Opioid Risk Tool; SOAPP: Screener and Opioid Assessment for Patients with Pain; COMM: Current Opioid Misuse Screen; PEG: Pain intensity, pain interference with Enjoyment of life and General activity; PHQ: Patient Health Questionnaire; GAD: Generalized Anxiety Disorder; PTSD: posttraumatic stress disorder; OSA: obstructive sleep apnea.

Sources:

Reproduced from: Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics 2009; 50:613. Table used with the permission of Elsevier Inc. All rights reserved.
Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108:812.
Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth 2012; 108:768.

Graphic 126456 Version 3.0

خرید پکیج

Evaluation of chronic non-cancer pain: Components and screening tools