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Assessment and Reassessment Tools

Pills are sorted

Often times, patients with a long-history of a pain diagnosis and opioid medication therapy are inherited by medical providers with little to no historical information as to the origin of the injury, imaging, and other pertinent medical history. It is essential to perform a thorough chart review and obtain historical records from specialists and previous primary care providers.

It is not uncommon to discover there is not a clinical indication for prolonged chronic opioid therapy such as an acute injury that occurred many years in the past and should not have been treated with opioids beyond what is clinically indicated, neuropathic pain syndromes that do not warrant opioids, or degenerative inflammatory disorders such as arthritis in which opioids are not indicated.

Periodic reassessment by obtaining a completely new and thorough pain history with appropriate imaging can mitigate inappropriate continuation of opioid medication therapy. A multi-modal treatment plan consisting of non-controlled medication therapy, physical therapy, psychotherapy, and other adjunctive therapies should be utilized in addition to or entirely in place of opioid medication therapy if assessment findings are consistent with a legitimate chronic pain syndrome.

If opioid medication therapy management is necessary, it is recommended to follow: The Model Policy for the Use of Controlled Substances for the Treatment of Pain [PDF – 44 KB] (drafted by the Federation of State Medical Boards Exit Disclaimer: You Are Leaving www.ihs.gov  of the United States).

Prescribing opioid medications for initial acute trauma or musculoskeletal injuries should be limited to 3 days and rarely past seven days unless benefits clearly outweigh risks. Opioids should be initiated at the lowest doses and quantities and, possibly, in conjunction with non-steroidal anti-inflammatories and muscle relaxants. If the pain persists, additional non-opioid medication and non-pharmacological therapy approaches should be considered as well as referrals to specialists.

Assessment tools:

  • Words to describe pain Intensity, Location, Duration, Aggravating/Alleviation (WILDA)
  • Brief Pain Inventory (BPI)- short form
  • Pain Disability Index (PDI)
  • Pain Assessment and Documentation Tool (PADT)
  • Physical Functional Ability Questionnaire (FAQ5)
  • Patient Health Questionnaire (PHQ-9) for depression

 

Assessment Tools Advantages Disadvantages
Words to describe pain: Intensity, Location, Duration, Aggravating/alleviating
  • Short and concise
  • Clinician-directed
  • Let's patient tell their story
  • Easy to remember
  • Less detailed for functional status, mood, quality of life
  • No section for aberrant behavior
Brief Pain Inventory
  • Brief and easy to follow
  • Patient can complete alone
  • Numeric scales easy for patient
  • Used in over 400 studies
  • Measures are not specific
Pain Disability Index
  • Quick and easy
  • Good for quality of life
  • Limited application to overall assessment (i.e. can't stand alone)
Pain Assessment and Documentation Tool
  • Clinician-directed
  • Simplified rankings for ADL measures
  • Covers recommended f/u points
  • Categorizes severity of ADR
  • Easy to follow checklists
  • Reliant upon physician to explain measures
  • May produce more clinician bias
Physical Functional Ability Questionnaire (FAQ5)
  • Good for mechanical pain
  • Quick and easy
  • Useful to establish baseline for physical rehab
  • Limited application to overall assessment (i.e. can't stand alone)
  1. Assessment tools measure essential characteristics associated with addiction in chronic pain populations and allow the patient a medium in which to express critical facts about how intense the pain is, what part of the body it originates, the type of pain, and how it impacts quality of life. They help monitor the patient's progress and prevent abuse of medication.
  2. A functional assessment should be routinely done at baseline, at least annually and if dose changes are being considered. It could be done in triage by the patient or mailed to the patient to complete and bring in prior to the appointment and reviewed with the clinician.

References

Fishman, MD, Scott M. Responsible Opioid Prescribing: A Physician's Guide. Washington, DC: Waterford Life Sciences, 2007. pp. 26-29, 98, 128, 130.

Mendoza, T., Mayne, T. Rublee, D., Cleeland, C. (May 2006). Reliability and Validity of a Modified Brief Pain Inventory Short Form in Patients with Osteoarthritis. European Journal of Pain. 10(4), 353-361.

Hooten WM, Timming R, Belgrade M, Gaul J, Goertz M, Haake B, Myers C, Noonan MP, Owens J, Saeger L, Schweim K, Shteyman G, Walker N. Institute for Clinical Systems Improvement. Assessment and Management of Chronic Pain. Updated November 2013.

"Use of Opioids for the Treatment of Chronic Pain: A statement from the American Academy of Pain Medicine". Updated February 2013. Accessed March 13, 2014

"Institute for Clinical Systems Improvement. Assessment and Management of Chronic Pain." Updated November 2013. Accessed March 13, 2014.