Assessment

The way clinicians use language can be stigmatising because patients can feel judged about the validity of their pain. This is a guide on how to use positive phrases that can improve patients’ health outcomes and self-reliance.

• Guide to positive language in pain consultations

Comprehensive Pain Assessment Outline

When to use

• Initial assessment and when appropriate

What to do

• Consider management strategies and use of further questionnaires if indicated

ACI Pain Assessment - PDF File 1.5 MB

Used as a baseline measure

When to use

• Use prior to trial of any strategy or review.

What to do

• Self report score > 4 indicates possible impairment or disability related to pain
• Develop a Pain Management Plan with ongoing review and refer where appropriate

Verbal Numerical Rating Scale - PDF File 383.2 KB

Visual Analogue Scale - PDF File 377.5 KB

Used as a baseline measure

When to use

• Use prior to trial of any strategy or review.

What to do

• Useful tool with children, elderly or CALD
• Self report score > 4 indicates possible impairment or disability related to pain
• Develop a Pain Management Plan with ongoing review and refer where appropriate

Faces Pain Scale Revised (FPS-R) - PDF File 116.3 KB

Clinical indicators of possible serious underlying conditions requiring further medical intervention

When to use

• Initial assessment

What to do

• ≥ 1 red flags indicates urgent referral to appropriate provider

Red Flags - PDF File 756.4 KB

Assists with neuropathic pain assessment

When to use  

• When neuropathic pain is suspected.

What to do

• Interview questionnaires and physical tests.
• If score ≥ 4, consider anti-neuropathic medication.

DN4 Assessment Tool - PDF File 22.5 KB

Assesses pain severity and interference. Validated screening and monitoring tool

When to use

• Initial Assessment
• Patient reviews and monitoring

What to do

• Median interference score of 6.6 at initial assessment indicates moderate disability.
• Develop a Pain Management Plan with ongoing review and refer where appropriate.
• PEG - Add three responses to questions then divide by three to get score out of 10. Most useful in tracking changes over time.

Brief Pain Inventory

PEG Pain Screening Tool - PDF File 1.3 MB

Development and Initial Validation of the PEG - PDF File 175.0 KB

Indicates risk for aberrant behavious

When to use

• When considering commencing  a person on opioids
• Opioid misuse concerns

What to do

• Scores > 3 indicate a moderate risk for aberrant behaviour
• Develop a Pain Management Plan and refer where appropriate

Opioid Risk Assessment Tool - PDF File 473.7 KB

Review of opioid medication

When to use

• On regular review.

What to do

• Difficulty in any area suggests the need for change in treatment.

5 A's of Analgesia - PDF File 692.0 KB

Psychosocial indicators suggesting increased risk of progression to long-term distress, disability and pain

When to use

• Initial assessment
• If considering prescribing opioids

What to do

• ≥ 1 yellow flag indicates need for psychological or mental health plan or referral  with ongoing review or Pain Management Plan
• Opioids are not a treatment for distress and unhelpful beliefs. Poor functional improvement with escalating use, side effects and aberrant behaviour would indicate reconsideration of opiates

Yellow Flags - PDF File 767.3 KB

New Zealand Acute Low Back Pain Guide
ACC
https://www.acc.co.nz/assets/provider/lower-back-pain-guide-acc1038.pdf

Measure of anxiety and depression

When to use

• Psychological distress.

What to do

• Scores > 19 indicate need for psychological or mental health plan or referral with ongoing review or Pain Management Plan.

Kessler 10 and scoring - PDF File 50.1 KB

Measure of anxiety and depression

When to use

• Anxiety or depression

What to do

• Scores > 15 indicate need for psychological or mental health plan or referral with ongoing review or Pain Management Plan.

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Screening tool to identify increase risk of prolonged pain and chronicity

When to use

• Early phase of assessment
• Predictor of increase risk of prolonged pain and disability

What to do

• PCS cut-off scores >30 are high risk for chronicity
• Develop a Pain Management Plan for risk targeted factors with ongoing review and refer where appropriate

Pain Catastrophizing Scale (PCS) Adult - PDF File 141.0 KB

Pain Catastrophizing Scale (PCS) Child - PDF File 81.0 KB

Pain Catastrophizing Scale (PCS) Multi Languages Link - MS Word Document 73.7 KB

Pain Catastrophizing Scale Manual - PDF File 3.5 MB

Predictor of long-term disability and failure to return to work

When to use

• Early phase of assessment (eg 4-12 weeks)
• Workers compensation
• Predictor of long term disability

What to do

• OMSPQ-10 - Cut-off score of >50/100 predicts an increased risk of disability.
• ÖMPQ - a cut-off score of 130 correctly predicts increase risk of disability.
• Develop a Pain Management Plan with ongoing review and refer where appropriate

Orebro short form OMPSQ-10 - PDF File 54.0 KB

Orebro musculoskeletal pain questionnaire - PDF File 178.0 KB

Predicts pain-related disability and confidence

When to use

• Early phase of assessment
• If concerns for pain related disability
• Determine patient confidence and self efficacy

What to do

• Scores of > 40 predictive of ability to work despite pain; lower scores indicate poor likelihood to work or engage in normal activities.
• Scores < 30 indicate need for help and linked to medication dependence
• Indicates need for ongoing review or Pain Management Plan and or appropriate referral

PSEQ - PDF File 743.5 KB

Used as a baseline measure

When to use

• Use prior to trial of any strategy or review.

What to do

• Self report score > 4 indicates possible impairment or disability related to pain
• Develop a Pain Management Plan with ongoing review and refer where appropriate

Verbal Numerical Rating Scale - PDF File 383.2 KB

Visual Analogue Scale - PDF File 377.5 KB

Used as a baseline measure

When to use

• Use prior to trial of any strategy or review.

What to do

• Self report score > 4 indicates possible impairment or disability related to pain
• Develop a Pain Management Plan with ongoing review and refer where appropriate

Visual Analogue Scale - PDF File 377.5 KB

Assesses pain severity and interference. Validated screening and monitoring tool

When to use

• Initial assessment
• Patient reviews and monitoring
• Useful tool with children, elderly or CALD

What to do

• Median interference score of 6.6 at initial assessment indicate moderate disability.
• Develop a Pain Management Plan with ongoing review and refer where appropriate.

Brief Pain Inventory

Faces Pain Scale Revised (FPS-R) - PDF File 116.3 KB

Predicts pain-related disability and confidence

When to use

• Early phase of assessment
• If concerns for pain related disability
• Determine patient confidence and self efficacy

What to do

• Scores of > 40 predictive of ability to work despite pain; lower scores indicate poor likelihood to work or engage in normal activities.
• Scores < 30 indicate need for help and linked to medication dependence
• Indicates need for ongoing review or Pain Management Plan and or appropriate referral

PSEQ - PDF File 743.5 KB

Predictor of long-term disability and failure to return to work

When to use

• Early phase of assessment (eg 4-12 weeks)
• Workers compensation
• Predictor of long term disability

What to do

• OMSPQ-10 - Cut-off score of >50/100 predicts an increased risk of disability.
• ÖMPQ - a cut-off score of 130 correctly predicts increase risk of disability.
• Develop a Pain Management Plan with ongoing review and refer where appropriate

Orebro short form OMPSQ-10 - PDF File 54.0 KB

Orebro musculoskeletal pain questionnaire - PDF File 178.0 KB

Prior to commencement of opioids

When to use

• Increase risk factors for sleep apnoea (eg. Neck circumference > 42 cm and Body Mass Index > 30)

What to do

• STOP BANG - High risk of OSA: yes to three or more items and Low risk of OSA: yes to less than three items
• If increased risk of sleep apnoea, caution must be taken with use of opioids

Obstructive Sleep Apnoea
Australasian Sleep Association
https://www.sleep.org.au/information/health-professionals-information/obstructive-sleep-apnoea

Obstructive Sleep Apnoea Guidelines - PDF File 1.4 MB

STOP BANG Questionnaire - PDF File 9.5 KB

Standard Drinks Guide - PDF File 327.0 KB