ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -15 مورد

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

Evaluation of chronic non-cancer pain: Components and screening tools
Patient self reported questionnaires
Pain severity impact: Pain intensity, pain interference with Enjoyment of life and General activity (PEG)[1]
  • 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?
 _____
Sleep difficulty: Does pain interfere with initiation and/or maintenance of sleep? (0 to 5 scale) _____
STOP-Bang[2] – Screen for obstructive sleep apnea when sleep difficulty is rated ≥2 or whenever sedatives or opioids are prescribed
  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
Mood
PHQ-4[3]
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 PTSD with PTSD-5
PTSD
PC-PTSD-5[4]
Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic.
For example:
  • A serious accident or fire
  • A physical or sexual assault or abuse
  • An earthquake or flood
  • A war
  • Seeing someone be killed or seriously injured
  • Having a loved one die through homicide or suicide
Have you ever experienced this kind of event? If 'No,' screen total = 0; if 'Yes,' continue with screening. Yes/No
In the past month, have you...
  1. Had nightmares about the event(s) or thought about the event(s) when you did not want to?
 Yes/No
  1. Tried hard not to think about the event(s) or went out of your way to avoid situations that reminded you of the event(s)?
 Yes/No
  1. Been constantly on guard, watchful, or easily startled?
 Yes/No
  1. Felt numb or detached from people, activities, or your surroundings?
 Yes/No
  1. Felt guilty or unable to stop blaming yourself or others for the events(s) or any problems the event(s) may have caused?
 Yes/No
Scoring: Significant score ≥3 for female patients, ≥4 for male patients
Opioid misuse: Screen when sedatives or opioids are prescribed, with ORT, SOAPP, COMM, or similar*
Body diagram*
Patient interview
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?")
Past medical and surgical history
Physical examination
Assess:
  • Overall condition (ie, gait, posture, deformity, balance)
  • Focal, regional or widespread pain
  • Evaluate for allodynia and/or sensory changes
  • Focal motor strength in painful and non-painful areas
PDMP – Check database prior to prescribing any scheduled drug
This table shows an example of the basic screening tools that can be used in the primary care setting for initial assessment of patients with chronic pain. Other tools may be indicated for patients with challenging pain syndromes or who screen positive for some of the assessed co-occurring conditions. This table should be used in conjunction with UpToDate content on evaluation of patients with chronic pain.

COMM: Current Opioid Misuse Screen; ORT: opioid risk tool; OSA: obstructive sleep apnea; PDMP: prescription drug monitoring program; PTSD: post traumatic stress disorder; SOAPP: Screener and Opioid Assessment for Patients with Pain.

* Forms or tables showing these tools are available in the UpToDate program.
References:
  1. Krebs EE, Lorenz KA, Bair MJ, et al. Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med 2009; 24:733.
  2. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008; 108:812.
  3. 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.
  4. Reprinted by permission from: Springer: Journal of General Internal Medicine. Prins A, Bovin MJ, Smolenski DJ, et al. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample. J Gen Intern Med 2016; 31:1206. Copyright © 2016. https://link.springer.com/journal/11606.
Graphic 126456 Version 5.0