Assessment
Assessment of pain should include: general medical history (including pain history), physical examination (neurological and musculoskeletal), psychosocial assessment, and diagnostic testing if applicable.
Use of appropriate assessment tools and resources will assist in populating the Pain Management Plan (GPMP + TCA).
Medical
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.
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.
PEG Pain Screening Tool - PDF File 1.3 MB
Development and Initial Validation of the PEG - PDF File 175.0 KB
Medications
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
Psychological
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.
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
To access the Pain Catastrophizing Scale go to Official PCS Pain Catastrophizing Scale distributed by Mapi Research Trust
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
Physical/Lifestyle
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.
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
Sleep Health Foundation
https://www.sleephealthfoundation.org.au/sleep-disorders/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
Specialised Populations Resources
Elderly Pain Assessment Tools and Resources
Abbey Pain Scale - PDF File 84.2 KB
Care of Confused Hospitalised Older Persons
NSW Agency for Clinical Innovation (ACI)
https://aci.health.nsw.gov.au/chops
Beyondblue - Older People
Beyondblue
http://www.beyondblue.org.au/resources/for-me/older-people
PAINAD and Scoring - PDF File 23.4 KB
Pain in Residential Aged Care Facilities - Management Strategies
Australian Pain Society
http://www.apsoc.org.au/publications
The PMG Kit for Aged Care
The Department of Health
https://www.apsoc.org.au/PDF/Publications/PMGKit_2007.pdf
Medical care of older persons in residential aged care facilities (silver book)
The Royal Australian College of General Practitioners
https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/silver-book/part-a/pain
Residential Medication Management Review
The 5CPA
http://5cpa.com.au/programs/medication-management-initiatives/residential-medication-management-review/
Paediatric Assessment Tools and Resources
A to Z Pain and School Tips for Parents - PDF File 374.8 KB
Coping Plan - PDF File 596.9 KB
Faces Pain Scale Revised (FPS-R) - PDF File 116.3 KB
Flare Up Plan - MS Word Document 1.2 MB
Flare Up Plan - PDF File 1.5 MB
Telephone Helplines and Links - PDF File 213.2 KB
Paediatric Pain in General Practice - PDF File 260.7 KB
Youth health resource kit
NSW Kids and Familes
https://www.health.nsw.gov.au/kidsfamilies/youth/Pages/youth-health-resource-kit.aspx
My Pain Toolkit for Teenagers / Young People
Pete Moore Pain Toolkit
http://www.paintoolkit.org
Tips for Parents and Carers - PDF File 402.9 KB
SMART Goals - MS Word Document 2.4 MB
SMART Goals - PDF File 2.6 MB
Tips for Siblings and Others - PDF File 200.6 KB
Culturally and Linguistically Diverse (CALD) Assessment Tools and Resources
Arthritis and Osteoporosis NSW CALD resources - MS Word Document 230.5 KB
Multicultural Information
Arthritis and Osteoporosis NSW
https://www.arthritisnsw.org.au/health-information/for-health-professionals/
Multicultural people
beyondblue
http://www.beyondblue.org.au/resources/for-me/multicultural-people
Cue Cards in Community Languages
Eastern Health
http://www.easternhealth.org.au/services/language-services/cue-cards/cue-cards-in-community-languages/item/481
Cultural Context and Pain Communication Toolkit - PDF File 1.6 MB
Manage Your Pain: Practical and Positive Ways to Adapt to Chronic Pain - Available in other languages
https://itunes.apple.com/au/book/manage-your-pain-3rd-edition/id468229940?mt=11
Multicultural Health Communication
NSW Health
http://www.mhcs.health.nsw.gov.au/
Pain scales in multiple languages
The British Pain Society
https://www.britishpainsociety.org/british-pain-society-publications/pain-scales-in-multiple-languages/
Pain Toolkit
https://www.paintoolkit.org/about/pain-toolkit
Translations of Brief Pain Inventory
The Department of Symptom Research, University of Texas MD Anderson Cancer Center
http://www.mdanderson.org/education-and-research/departments-programs-and-labs/departments-and-divisions/symptom-research/symptom-assessment-tools/brief-pain-inventory.html
Translations of the DASS 21
University of New South Wales
http://www2.psy.unsw.edu.au/dass/translations.htm