Download Suggested steps to better early behavioral management

Pain Management Tools
Assessment
Pain Diagram
3
Psychosocial Yellow Flags:
Helping Someone at Risk
Suggested steps to better early
behavioral management of low
back pain problems
The information presented here is taken entirely, without any content modification from: Kendall, N A S, Linton, S J & Main, C J (1997). Guide to Assessing Psycho-social Yellow Flags in Acute Low
Back Pain: Risk Factors for Long-Term Disability and Work Loss. Accident Compensation Corporation and the New Zealand Guidelines Group, Wellington, New Zealand. (Oct, 2004 Edition).
Red Flags
Possible tumour or infection
Possible
fracture
Possible
significant
neurological
deficit
From history
• Major trauma
• Minor trauma
in elderly or
osteoporotic
• Age >50 or <20 years
• History of cancer
• Constitutional symptoms
(fever, chills, weight loss)
• Recent bacterial infection
• IV drug use
• Immunosuppression
• Pain worsening at night or
when supine
• Severe or
progressive
sensory
alteration or
weakness
• Bladder or
bowel
dysfunction
From physical examination
• Evidence of neurological deficit (in legs or perineum in the case of
low back pain)
PHQ-9
6
GAD-7
7
Pain Catastrophizing Scale
Statement

Rating
1
I worry all the time about whether the pain will end
2
I feel I can’t go on
3
It’s terrible and I think it’s never going to get any better
4
It’s awful and I feel that it overwhelms me.
5
I feel I can’t stand it anymore
6
I become afraid that the pain will get worse.
7
I keep thinking of other painful events
8
I anxiously want the pain to go away
9
I can’t seem to keep it out of my mind
10
I keep thinking about how much it hurts
11
I keep thinking about how badly I want the pain to stop
12
.There’s nothing I can do to reduce the intensity of the pain
13
I wonder whether something serious may happen
RATING

MEANING
0
1
2
3
Not at all
To a slight
degree
To a moderate
degree
To a great
degree
The Pain Catastrophizing Scale: Development and Validation, Michael J. L. Sullivan, Scott R. Bishop and Jayne Pivik, Psychological Assessment, 1995, Vol. 7, No. 4, 524-532
4
All the
time
DN4
9
Goals Decided with Patient:
1.
2.
3.
4.
5.
6.
7.
11
Initiation Checklist
Are opioids indicated for this pain
condition
Explained potential benefits
Explained adverse effects
Explained risks
Patient given information sheet
Signed treatment agreement (as needed)
Urine drug screening (as needed)
Conditions Opioids Have Efficacy In:




Osteoarthritis
Rheumatoid arthritis
Neuropathic pain
Mixed nociceptive and neuropathic states
Limited evidence or no efficacy in:
 Fibromyalgia
 Headache disorders
13
13
Algorithm
20