1 Measuring Pain

Question 1

What is the proposed scheme from Main and George 2011?

Answer 1

Core philosophy: incorporating patient beliefs, attitudes, and emotional response into patient management based on biopsychosocial models

Goals: Secondary prevention of disability

Question 2

Red flags

Answer 2

Signs of serious pathology

Cauda Equina, fracture, tumor

Question 3

Orange flags

Answer 3

Psychiatric symptoms (depression, personality disorder)

Question 4

Black flags

Answer 4

Health care system (limitations) - Legalizations, insurance limitations

Question 5

Blue Flags

Answer 5

Work related factors

Belief that work is likely to cause injury or supervisor is unsupported (work responsible)

Question 6

Yellow flags

Answer 6

Beliefs, judgements, appraisals (pain catastrophising)

Emotional responses (worry, fears, anxiety)

Pain behavior (avoidance of activity due to pain)

Question 7

Depression screening questions

Answer 7

during past month, bothered by feeling by down, depressed, or hopeless?

During the past month, have u been bothered by little interest or pleasure doing things

yes to both = severe depression

Would you like help now?

Question 8

PHQ - 9

Answer 8

If the pt answers yes to the 2 questions
- asses diagnosis and severity of depression
Q 9 = sucidal ideation

Change in depression over time

Question 9

PHQ 9 final question

Answer 9

10. anything other than “not difficult” = considered positive

Question 10

PHQ 9 scores

Answer 10

0-4 non

5-9 mild

10-14 mod

15-19 mod severe

20-27 severe depression

Question 11

Orebro MSK screening questionnaire

Answer 11

21 items for work injury patients at risk of persistent msk problems

shortened 12 question dev for general msk populations

Score over 72 follow up with other questionnaire

Question 12

STarT Back

Answer 12

Subgroups or targeted treatment back screening tool

Developed for back pain to assist general practitioner refer for appropriate management

Question 13

STarT Back Scores

Answer 13

Low risk < 4
- Primary care management

Med Risk >4
- PT?

High risk >4 modified treatment (physical and cognitive behavioral approach)

Question 14

FABQ

Answer 14

For elevated fear avoidance beliefs

Physical activity scale > 15

Work scale > 29

Needs other interventions W >22

Question 15

Tampa Scale of Kinesiophobia

Answer 15

Fear of injury and movement - Kinesiophobia

No cut offs

above 50 percentile = suspicion of psychological influence

above 75 positive for psych influence

Question 16

Fear of daily activities (FDAQ)

Answer 16

10 items
rate fear on Visual analog scale
AVG 10 items on FDAQ score
Consider highly rate movements/activities to intervention

Question 17

Pain catastrophizing assessment PCS

Answer 17

elevated pain catastrophizing

I worry all the time when pain will end

I keep thinking about how much it hurts

Theres nothing i can do to reduce pain

50% = suspicion psych influence

75% positive for psych influence