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Industry: Email Alert RSS FeedApproach to assessment and diagnosis of chronic pain
Journal of Family Practice, Oct, 2004 by Stephen Brunton
* PAIN ASSESSMENT TOOLS
Numerous tools have been developed and validated to assist in the assessment of pain (TABLE 4). (11,18-23) Those that are easiest to use have limited value, as they measure pain intensity only (unidimensional). Multidimensional tools assess several aspects of pain such as intensity, frequency, temporal nature, impact on quality of life, etc. Consequently, multidimensional tools are more difficult to complete, are time-consuming, and require expert interpretation. One notable exception is the short form of the Brief Pain Inventory (BPI). The BPI asks patients to identify the location of their pain on a diagram of the body, and it assesses the pain at its worst, least, and average intensity using a simple Likert scale to assess the impact of pain on activities of daily living. Multidimensional tools often assess the psychosocial factors that may be contributing to the pain. Since they provide more detailed information than unidimensional tools, multidimensional tools are particularly valuable in the evaluation of patients with complex pain syndromes. Selection of an appropriate pain assessment tool should take into consideration the person's cognitive development, language, culture, and preferences. It is prudent to use the same pain assessment tool for the person on subsequent assessments to facilitate reliable evaluations of changes in the pain. [Evidence level B: There is evidence of types II, III, or IV, and findings are generally consistent. II. Well-designed experimental studies. III. Well-designed, quasiexperimental studies, such as nonrandomized controlled, single-group prepost, cohort, time series, or matched-case controlled studies. IV. Well-designed nonexperimentat studies, such as comparative and correlational descriptive and case studies. Available at: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3691&nbr=2 917&string=chronic%20AND%20pain%20AND%20diagnosis.]
The Numeric Rating Scale (NRS), Verbal Rating Scale (VRS), and Visual Analogue Scale (VAS) are widely used unidimensional scales that lend themselves to the primary care setting more readily than do the multidimensional tools. The NRS and VRS require the patient to rate the pain intensity on a scale from 0 to 10 (FIGURE 2), while the VAS uses a nongraduated 10-cm line. These 3 scales are simple to use, yield reproducible results, and are easily understood by most types of patients. The Faces Pain Rating Scale depicts images of facial expression ranging from a happy, smiley face to a very distressed, teary face (FIGURE 3). This type of scale is commonly used when communication may be difficult (eg, in young children and cognitively impaired adults).
[FIGURES 2-3 OMITTED]
The uni- and multidimensional pain assessment tools are reliable and valid measures of pain intensity and pain unpleasantness. Since they do not adequately assess the domains affected by NP, the Neuropathic Pain Scale (NPS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were developed. The NPS includes 2 items that assess the global dimensions of pain intensity and pain unpleasantness, as well as 8 items that assess specific qualities of NP. (16) An eleventh item assesses the temporal sequence of pain. The LANSS is a 2-part tool consisting of a patient-completed questionnaire and a brief clinical assessment of sensory dysfunction. (24) Its use provides immediate information in clinical settings. (25,26)
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