Assessing pain with a new tool
Tuesday, July 03, 2018
Although estimates of the prevalence of chronic pain vary, the number of persons experiencing chronic pain in the United States is substantial.
According to a new study prepared by National Institutes of Health’s National Center for Complementary and Integrative Health, an estimated 25.3 million adults (11.2 percent) experience chronic pain — that is, pain every day for the preceding three months. Nearly 40 million adults (17.6 percent) experience severe levels of pain.
Based on a survey conducted from 2001-03, the overall prevalence of common, predominantly musculoskeletal pain conditions (e.g., arthritis, rheumatism, chronic back or neck problems, and frequent severe headaches) was estimated at 43 percent among adults in the U.S.
Chronic pain can influence a patient’s thoughts and moods, causing them to isolate from others or be unable to achieve the mobility they once had. In addition, chronic pain can stem from conditions other than physical injuries, such as heart disease, arthritis, migraines or diabetes.
Patients who present with a high number of physical symptoms may be more likely to have a mood disorder than patients who present with only a few physical symptoms.
Often, it can be difficult to assess whether chronic pain has led to depression, or vice versa. People with chronic pain are three times more likely to develop symptoms of depression or anxiety, and people with depression are three times as likely to develop chronic pain.
Sometimes pain and depression create a vicious cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain.
Although chronic pain should be diagnosed by a qualified healthcare provider after a careful history and physical exam and any additional studies, chronic pain in this population of patients with complex circumstances can be difficult to treat. In fact, it is estimated that 40 percent to 60 percent of patients with chronic pain have inadequate pain management.
To address this issue, clinicians and researchers at the University of Washington's Center for Pain Relief found the use of an in-depth questionnaire tremendously helpful. The "Pain Tracker" can be filled out online from any digital device or completed on paper.
The assessment, which includes a body diagram to pinpoint painful areas, addresses the patient’s treatment history, goals and expectations, pain intensity, pain-related disability, issues with pain medications, and quality-of-life issues, such as sleep, depression and anxiety.
Then, before each follow-up appointment, patients complete a subset of questions that provides a visual graph showing areas of improvement (e.g., sleep, function and mood) which often occurs before reduction in pain.
According to David Tauben, UW chief of pain medicine and a co-author of the paper, the tool has dramatically transformed his ability to properly assess, treat and manage chronic pain more than the widely used 0 to 10 pain rating scale.
Currently, Pain Tracker is only used at the UW Center for Pain Relief, but includes more than 12 freely available tests, including the Alcohol Use Disorders Identification Test (AUDIT), fibromyalgia symptoms (FS), Generalized Anxiety Disorder 7-item scale (GAD-7), Opioid Risk Tool (ORT), snoring, tiredness, observation of stopped breathing (STOP), high blood pressure, and widespread pain index (WPI).
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