Download 10. Assessment and Treatment of Chronic Pain

Pain and Feigning: Seminar References
Presentation by IMO Pty Ltd to clients on
27th February 2014 (Sydney) and
13th March 2013 (Melbourne)
Event facilitator: Mr Steven Tipper
BAppSc(BiomedSc), MHA, FCHSM
Executive Director Clinical Services
IMO Pty Ltd
NOTE: This document of slide references & a bibliography is
accessible via the IMO website blog: see www.imo.net.au ‘blog’
References: Slides (numbering based on Melbourne presentation)
Slide 7. The Biopsychosocial Approach to Chronic Pain .. RJ Gatchel. American
Psychological Association. Psychological Bulletin 2007, Vol. 133, No. 4, 581–624
Figure 1. A conceptual model of the biopsychosocial interactive processes involved in health
and illness. From “Comorbidity of Chronic Mental and Physical Health Conditions: The
Biopsychosocial Perspective” by R. J. Gatchel, American Psychologist, 59, 792–805.
Slide 8. http://projects.hsl.wisc.edu/GME/PainManagement/session2.1.html
Cites: International Association of the Study of Pain ‘Implication for Clinical Practice’
refer website sidebar http://pimg.mhcc.org.au/chapter-3/3-2.aspx
Slide 9. Basic Definitions & Clinical Implications (online course)
http://projects.hsl.wisc.edu/GME/PainManagement/session2.1.html
Slide 10. Pain Terminology: For a list of definitions of terms used in pain management see:
http://www.iasppain.org/AM/Template.cfm?Section=Pain_Definitions&Template=/CM/HTMLDisplay.cfm&Co
ntentID=1728
Slide 12: Nociception
SOURCE: Explain Pain: (Revised Updated, 2nd Edition) David S Butler, G Lorimer Moseley
IMAGE SOURCE:
http://books.google.com.au/books?id=d58cfvw8nh0C&pg=PT34&source=gbs_selected_pag
es&cad=3#v=onepage&q&f=false
Slides 11-14: Variously from Explain Pain: (Revised Updated, 2nd Edition) David S Butler,
G Lorimer Moseley
Explain_Pain_2nd_edn_Evidence_Base_0813_noi (EXCELLENT SUMMARY & REFs:
http://www.noigroup.com/documents/noi_explain_pain_2nd_edn_evidence_base_0813.pdf)
Slide 15. Pathophysiology
http://projects.hsl.wisc.edu/GME/PainManagement/session2.3.html
Slide 16. Pain Classification
Table 1. http://projects.hsl.wisc.edu/GME/PainManagement/tables.html?panel=0
Pain & Feigning_References&Bibliography_20140313_final.doc © Copyright IMO Pty Ltd
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www.imo.net.au
Slide 17. Neuropathic Pan
EXPLAIN PAIN – SECOND EDITION David S. Butler and G. Lorimer Moseley
Slide 18. Neuropathic pain syndromes
An Update on Neuropathic Pain Stefanie Rehm, Jana Koroschetz, Ralf Baron
European Neurological Review, 2008;3(1):125-127
http://www.touchneurology.com/articles/update-neuropathic-pain
Slide 19. Neuropathic pain assessment
Neuropathic Pain Assessment – An Overview of Existing Guidelines and Discussion Points
for the Future Nurcan Üçeyler, Claudia Sommer European Neurological Review, 2011;6(2):128131
Slide 20. 1 in 4 GP patients has chronic pain
Catherine Hanrahan Medical Observer 6th Aug 2013
Source1: http://www.medicalobserver.com.au/news/one-in-four-gp-patients-has-chronic-pain
CITES: Pain Medicine 2013; online 15 July
NOTES: GP Pain Help App: The Australian College of Rural and Remote Medicine (ACRRM) and
the Centre for Palliative Care Research and Education (CPCRE) have jointly developed a free app
and website for GPs to help better manage patients in pain at or near the end of their lives.
The app includes a treatment decision tree, a section on types of pain and various analgesics,
breakthrough pain information, a dose conversion tool, patient FAQs, pain management and
palliative care resources and a troubleshooting section.
The content has been developed by the Centre for Palliative Care Research and Education
(CPCRE) and the app and website by the Australian College of Rural and Remote Medicine.
Source2.:
http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1672:app-tohelp-gps-help-patients-in-pain&catid=16:australian-ehealth&Itemid=328
GP Pain App Resource (download): http://www.gppainhelp.com/Title.html
Slide 21-23. Phases of pain treatment
Assessment and Treatment of Chronic Pain - A physician’s guide to a biopsychosocial
approach. By John Mark Disorbio, EdD, Daniel Bruns, PsyD and Giancarlo Barolat, MD
http://www.practicalpainmanagement.com/treatments/psychological/assessment-treatmentchronic-pain
Slide 25. Malingering pain in a medico legal context
Slide 26. Who says so?
http://scholar.google.com/scholar?as_sdt=0,5&hl=en&sciodt=2006&cites=1628908839770489545
7&scipsc= Citation (1): Mendelson, G., and D. Mendelson. "Malingering pain in the medicolegal
context." The Clinical journal of pain 20.6 (2004): 423.
http://paincenter.stanford.edu/iasp/iasp/Full%20PDF/M.%20George%20Mendelson,%20Day%202.pdf
Slide 29. Tests vs. testing? Knowing the difference.
NOTES: OMPQ = The Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) is a ‘yellow flag’
screening tool that predicts long-term disability and failure to return to work when completed four to
12 weeks following a soft tissue injury. NSW WorkCover website for downloadable form:
http://www.workcover.nsw.gov.au/formspublications/publications/Pages/WC05537_OrebroMusculo
skeletalPainQuestionnaireOM_.aspx
Orebro Musculoskeletal Pain Questionnaire (OMPQ) remains WorkCover’s preferred
initial formal screening tool for workers with soft tissue injury.
http://www.workcover.nsw.gov.au/formspublications/publications/Documents/faqs_improving_outc
omes_soft_tissue_injury_5612.pdf
Pain & Feigning_References&Bibliography_20140313_final.doc © Copyright IMO Pty Ltd
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ABN 82 051 354 922 · National Head Office: Level 9, 175 Castlereagh Street Sydney NSW 2000 · PO Box A2630 Sydney
South NSW 1235 · DX 1497 SYDNEY · Ph 13 88 28 · Fax (02) 9267 5599 · Email [email protected] · www.imo.net.au
Slide 32. Universal Pain Assessment Tool
Source: Figure 2 Universal pain Assessment Tool
IndianJDentRes_2012_23_2_295_100460_f8
http://www.ijdr.in/viewimage.asp?img=IndianJDentRes_2012_23_2_295_100460_f8.jpg
Slide 33. painDETECT
See also “painDETECT appraisal” (1-page)
http://ajp.physiotherapy.asn.au/AJP/vol_59/3/Clinimetrics.pdf
SEE ALSO: painDETECT Questionnaire
S Mathieson, C Lin - Journal of Physiotherapy, 2013 - ajp.physiotherapy.asn.au
NOTES: The painDETECT questionnaire was specifically developed to detect neuropathic pain
components in adult patients with low back pain (Freynhagen et al 2006) and is recommended for
use by non-specialists (Gauffin et al 2013).
http://ajp.physiotherapy.asn.au/AJP/vol_59/3/Clinimetrics.pdf
Slide 34. Psychological testing
Assessment and Treatment of Chronic Pain
A physician’s guide to a biopsychosocial approach.
By John Mark Disorbio, EdD, Daniel Bruns, PsyD and Giancarlo Barolat, MD
http://www.practicalpainmanagement.com/treatments/psychological/assessment-treatmentchronic-pain Accessed 21 February 2014
RESEARCH NOTE: “One of the biggest challenges with initiating multidisciplinary assessment or
treatment often involves getting the patient to accept a psychological referral.” (page 4)
Slide 36, 37. Compensable Injuries and Health Outcomes
Compensable Injuries and Health Outcomes, The Royal Australasian College of Physicians,
Sydney 2001 http://www.activeohs.com.au/wp-content/uploads/2013/08/Compensable-InjuriesHealth-Outcomes2.pdf
Bibliography (other reading & reference material)
1. International Association for the Study of Pain
1.1 Resources: Find lists of organizations and publications devoted to patient care, research,
clinical practice, and education.
http://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1892&navItemNumber=650
NOTE: As part of its educational mission, IASP has made several books freely available for
educational purposes. These publications are free of charge to IASP members and the general
public.
http://www.iasppain.org/PublicationsNews/Content.aspx?ItemNumber=1957&navItemNumber=677
1.2 IASP Free full text overview articles recommended by the IASP:
http://www.caresearch.com.au/caresearch/tabid/748/Default.aspx
includes Review Article:
 Assessment of pain Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L,
Hals EK, et al. Br. J. Anaesth. 2008 Jul;101(1):17-24. Epub 2008 May 16.
http://bja.oxfordjournals.org/content/101/1/17.full.pdf+html
1.3 Faces Pain Scale - Revised Home — January 31, 2014
The Faces Pain Scale – Revised (FPS-R) was adapted from the Faces Pain Scale in order to
make it possible to score on the widely accepted 0-to-10 metric. http://www.iasppain.org/Education/Content.aspx?ItemNumber=1519
Pain & Feigning_References&Bibliography_20140313_final.doc © Copyright IMO Pty Ltd
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ABN 82 051 354 922 · National Head Office: Level 9, 175 Castlereagh Street Sydney NSW 2000 · PO Box A2630 Sydney
South NSW 1235 · DX 1497 SYDNEY · Ph 13 88 28 · Fax (02) 9267 5599 · Email [email protected] · www.imo.net.au
Faces Pain Scale – Revised, ©2001, International Association for the Study of Pain
[ www.iasp-pain.org/FPSR] cites
Hicks CL, von Baeyer CL, Spafford P, van Korlaar I, Goodenough B. The Faces Pain Scale Revised: Toward a common metric in pediatric pain measurement. Pain, 2001;93:173-183.
2. Abbey Pain Scale
For measurement of pain in people with dementia who cannot verbalise.
Abbey, J; De Bellis, A; Piller, N; Esterman, A; Giles, L; Parker, D and Lowcay, B. Dementia Care
Australia Pty Ltd http://www.apsoc.org.au/PDF/Publications/4_Abbey_Pain_Scale.pdf
3. ‘Capacity’ References
[1] An, E. D. “How and when to assess capacity.” (titled “Decision-making capacity & dementia – A
guide for Health Care Professionals in NSW – Mini-legal kit Series 1.7”)
[2] Moye, Jennifer, Daniel C. Marson, and Barry Edelstein. “Assessment of capacity in an aging
society.” American Psychologist 68(3), Apr 2013, 158-171. doi: 10.1037/a0032159
[5] “When a Client’s Capacity is in Doubt: a practical guide for solicitors”, Law
Society of NSW 2009.
Above 3 references from LONIE_Jane_20140221_IMO Client Newsletter_FINAL.msg available
from IMO website www.imo.net.au from the Blog (menu link)
4. Mental Health Coordinating Council (MHCC) Psychological Injury Management Guide
(PIMG)
NOTE: see section 4.2 About Workers Compensation Insurers
http://pimg.mhcc.org.au/chapter-4/4-2.aspx
Section 4.2.3 insurer Relationship Management links to a Fact Sheet:
http://pimg.mhcc.org.au/media/2276/understanding-insurance-relationship-management.pdf
NOTE: The MHCC also provides a Form: Record of Contact with Insurer
5. IMPROVING OUTCOMES: INTEGRATED, ACTIVE MANAGEMENT OF WORKERS WITH
SOFT TISSUE INJURY WorkCover NSW Catalogue No. WC05612
http://www.workcover.nsw.gov.au/formspublications/publications/Documents/faqs_improving_outc
omes_soft_tissue_injury_5612.pdf
6. Psychological Approaches to Pain Management, Second Edition: A Practitioner's
Handbook (Google eBook) Dennis C. Turk, Robert J. Gatchel. Guilford Publications, 9 Dec 2013 Psychology - 590 pages
SEE Google Books on-line (e-print) preview of over 500 pages.
Download Chapter 1 of text currently FREE ‘sample’ (link below):
Designed for maximum clinical utility, this volume shows how to tailor
psychological treatment programs to patients suffering from a wide
range of pain problems. Conceptual and diagnostic issues are
discussed, widely used clinical models reviewed, and a framework
presented for integrating psychological treatment with medical and
surgical interventions.
http://books.google.com.au/books?hl=en&lr=&id=ngBPAgAAQBAJ&oi=fnd&pg=PA3&dq=pain+b
iopsychosocial+mechanisms+and+management&ots=zW7ToXvdh3&sig=mbhTqfFsBOxnP4Py59v4F2W3eU#v=onepage&q=pain%20biopsychosocial%20mechanisms%20and%20man
agement&f=false
7. Explain Pain: (Revised and Updated, 2nd Edition) David S Butler, G Lorimer Moseley
NOTE: for a simple 2 page summary of the evidence-base see:
noi_Explain_Pain_2nd_edn_Evidence_Base_0813 (EXCELLENT SUMMARY & REFs:
http://www.noigroup.com/documents/noi_explain_pain_2nd_edn_evidence_base_0813.pdf)
8. Patients’ Perceptions of Their Illness: The Dynamo of Volition in Health Care
Keith J. Petrie and John Weinman
Pain & Feigning_References&Bibliography_20140313_final.doc © Copyright IMO Pty Ltd
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ABN 82 051 354 922 · National Head Office: Level 9, 175 Castlereagh Street Sydney NSW 2000 · PO Box A2630 Sydney
South NSW 1235 · DX 1497 SYDNEY · Ph 13 88 28 · Fax (02) 9267 5599 · Email [email protected] · www.imo.net.au
Current Directions in Psychological Science February 2012 21: 60-65,
doi:10.1177/0963721411429456 Abstract Full Text(HTML) Full Text (PDF)
http://cdp.sagepub.com/content/21/1/60.full.pdf+html
9. Psychologists as Primary Care Providers
Ron Lechnyr, PhD, DSW and Terri A. Lechnyr, PhD, MSW, LCSW Practical Pain Management
http://www.practicalpainmanagement.com/treatments/psychological/psychologists-primary-careproviders
10. Assessment and Treatment of Chronic Pain
A physician’s guide to a biopsychosocial approach.
By John Mark Disorbio, EdD, Daniel Bruns, PsyD and Giancarlo Barolat, MD
http://www.practicalpainmanagement.com/treatments/psychological/assessment-treatmentchronic-pain NOTE: QUOTED in .ppt seminar re: phase of pain treatment
RESEARCH NOTE: “One of the biggest challenges with initiating multidisciplinary assessment or
treatment often involves getting the patient to accept a psychological referral.” (page 4)
11. Complex Regional Pain Syndrome Fact Sheet
NINDS. Publication date June 2013. NIH Publication No. 13-4173
http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystro
phy.htm (Reference_CRPS_FactSheet_NINDS_June 2013.pdf)
12. Evidence based guidelines for complex regional pain syndrome type 1.
Perez RS, Zollinger PE, Dijkstra PU, Thomassen-Hilgersom IL, Zuurmond WW, Rosenbrand KC,
Geertzen JH; CRPS I task force.
BMC Neurol. 2010 Mar 31;10:20. doi: 10.1186/1471-2377-10-20. [Open Access complete
electronic version] http://www.biomedcentral.com/1471-2377/10/20
13. painDETECT: …..(long title truncated)
by R Freynhagen.Curr Med Res Opin. 2006 Oct;22(10):1911-20. painDETECT: a new screening
questionnaire to identify neuropathic components in patients with back pain.
www.ncbi.nlm.nih.gov/pubmed/17022849
See also “painDETECT appraisal” (1-page)
http://ajp.physiotherapy.asn.au/AJP/vol_59/3/Clinimetrics.pdf
SEE ALSO: painDETECT Questionnaire
S Mathieson, C Lin - Journal of Physiotherapy, 2013 - ajp.physiotherapy.asn.au
The painDETECT questionnaire was specifically developed to detect neuropathic pain
components in adult patients with low back pain (Freynhagen et al 2006) and is
recommended for use by non-specialists (Gauffin et al 2013).
http://ajp.physiotherapy.asn.au/AJP/vol_59/3/Clinimetrics.pdf
14. Pain Management– Assessment Steps. Chronic Pain History: “PQRST”
 Provocative/palliative factors (e.g., position, activity, etc.)
 Quality (e.g., aching, throbbing, stabbing, burning)
 Region (e.g., focal, multifocal, generalized, deep, superficial)
 Severity (e.g., average, least, worst, and current)
 Temporal features (e.g., onset, duration, course, daily pattern)
 Medical History (Existing comorbidities, Current medications)
Source: Valley, MA. Pain measurement. In: Raj PP. Pain Medicine. St. Louis MO. Mosby, Inc.
1996:36-46.
15. Assessment Tools: Visual Analogue Scales ; Facial Pain Scales ; Numeric Rating Scales ;
Verbal Rating Scales ; Multidimensional tools (McGill PQ Pain map); Multiple others – at least 12
different behavioral based tools for patients with dementia
SOURCE: http://www.authorstream.com/Presentation/sreenu2002-1924524-pain-managementspecial-populations-warangal-final-copy/ (presentation transcript)
Pain & Feigning_References&Bibliography_20140313_final.doc © Copyright IMO Pty Ltd
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ABN 82 051 354 922 · National Head Office: Level 9, 175 Castlereagh Street Sydney NSW 2000 · PO Box A2630 Sydney
South NSW 1235 · DX 1497 SYDNEY · Ph 13 88 28 · Fax (02) 9267 5599 · Email [email protected] · www.imo.net.au