Pain Assessment

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Pain phases

When assessing pain it is important to recognise the differences between acute and chronic pain and the implications for assessment and management of the patient. each of these phases presents:

1. Acute - In the acute pain phase performance of a comprehensive assessment using reliable and validated tools to prevent the onset of chronicity is of utmost importance.
2. Subacute
3. Chronic
   

Pain assessment

When assessing pain we use a biopsychosical approach for assessment of pain and disability as it accounts for the multidimensional nature of pain in domains relevant to physical therapy practice.

A biopsychosocial assessment should seek to identify the following:

• Bio (triage and identification of the pathology)
• Psycho (psychological distress, fear/avoidance beliefs, current coping methods and attribution)
• Social (work issues, family circumstances and benefits/economics)

During our assessment we must account for the multidimensional nature of pain by including appropriate assessment measures for primary domains including:

• Sensory
• Affective
• Cognitive
• Physiological
• Behavioral

Pain measures

Commonly used measures for different pain dimensions include:

• Self-report measures
• Physical performance measures including Functional Capacity Evaluations (FCEs)
• Physiological/autonomic response measures 
  

These measures each have their own strengths and limitations for different pain dimensions which we must recognise:

Self report measures

• Numerical Rating Scale
• Visual Analogue Scale
• Patient Global Impression of Change
• The short-form McGill Pain Questionnaire
• Brief Pain Inventory short form
• West Haven-Yale Multidimensional Pain Inventory
• Treatment Outcomes of Pain Survey

An individual’s ability to persist through a questionnaire depends on a number of individual and environmental factors (eg, attention span, interest in the scale, dedication to the project, incentives, outside distracters, or item complexity). Conservatively, questionnaire packets should be able to be completed by the majority of individuals in under 25 minutes. These longer packets may also be combined with more frequently administered, single-item measures to provide a balance of depth of information and temporal resolution

Physical performance measures

Many physical functioning and performance tests, such as range-of-motion, exist and have been used as a proxy for objective pain measurement. Examples of standardized performance/functioning tests for chronic pain include the following:

the loaded forward-reach test for chronic back pain

timed “Up & Go” test for osteoarthritis

grip strength for rheumatoid arthritis

In general, these performance tests only modestly predict self- reported pain, with correlations rarely exceeding 0.30 [32-36]. These results suggest that pain is just one component of physical performance, and other factors, such as fear of pain, may heavily impact performance scores [37,38]. Therefore, although clinic-based tests of

Individualised assessment

It is important to modify pain assessment strategies to match inherent variability associated with the patient's clinical presentation:

• Individual factors (e.g. age, sex, etc.)
• Sociocultural influences (e.g. spirituality, ethnicity, etc.)
• Clinical characteristics of pain (e.g. duration, anatomical location, etc.)
• Pain type and state (e.g. neuropathic pain, cancer pain, etc.)
• Vulnerable populations (e.g. communication barriers, cognitive impairment etc.)

Outcomes of pain assessment

Following assessment of pain suitable management strategies can be implemented.  However, as always, it is important to understand the need to:

1. monitor and review the effectiveness of treatment/management and modify treatment and management strategies appropriately.
2. refer to relevant health professional as appropriate and in a timely manner.
   

References

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