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Pain Phases[edit | edit source]When assessing pain, it is important to recognise the differences between acute and persistent/chronic pain and the implications for assessment and management of the patient:
Pain Assessment[edit | edit source]Often 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:
During our assessment we must account for the multidimensional nature of pain by including appropriate assessment measures for primary domains including:
The effects of pain can be complex and can traverse many intersecting domains. Pain Measures[edit | edit source]Despite the difficulty inherent to measuring pain, there are a number of accepted tools for tracking pain-related treatment outcomes. The proper use of these tools can allow clinicians and researchers to demonstrate both statistically and clinically significant treatment effects. Commonly used measures for different pain dimensions include:
Chronic pain has multiple effects on patients, so outcome measures cover several domains:
These measures each have their own strengths and limitations for different pain dimensions which we must recognise: Self Report Measures[edit | edit source]Pain Scales:
Pain Interference:
Physical Function:
Quality of Life:
Emotional Distress / Functioning:
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[1] Physical Performance Measures[edit | edit source]Many physical functioning and performance tests, such as range-of-motion, exist and have been used as a proxy for objective pain measurement[2]. Examples of standardised performance/functioning tests for chronic pain include the following:
Pain is just one component of physical performance, and other factors, such as fear of pain, may heavily impact performance scores. Therefore, although clinic-based tests of functioning can complement self-reported pain measures in chronic conditions, they are not useful as a pain-report substitute[1]. Physiological/Autonomic Response Measures[edit | edit source]Younger[1] states that the field of pain management would benefit enormously from an objective, physiologic marker of pain and describes how several physiologic variables, such as skin conductance and heart rate, have been measured for this purpose. In general, however, these markers do not correlate strongly enough with pain to warrant their use as a surrogate measure of pain. Pain can exist in the absence of changes in these measures, and these measures can fluctuate drastically with no change in pain. These peripheral measures indicate general autonomic activity, which can be influenced by many factors other than pain, such as other forms of arousal. Also, treatments may directly impact those physiologic variables, further reducing their reliability as a clean pain measure. Work still continues in this area, with tests of more sophisticated measurement approaches or biomarkers of pain intensity. Individualized Assessment[edit | edit source]It is important to modify pain assessment strategies to match inherent variability associated with the patient's clinical presentation:
Outcomes of Pain Assessment[edit | edit source]Following assessment of pain suitable management strategies can be implemented. However, as always, it is important to understand the need to:
An excellent ressource on this topic is the British Pain Society. You can find a compilation of their Pain Outcome Measures here: https://www.britishpainsociety.org/static/uploads/resources/files/Outcome_Measures_January_2019.pdf Resources[edit | edit source]
References[edit | edit source]
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