Comprehensive Initial Assessment for Pain Management Patients
A thorough biopsychosocial assessment is essential for all new pain management patients, including standardized screening, comprehensive evaluation of pain characteristics, physical examination, psychosocial evaluation, and appropriate diagnostic workup to determine the potential cause of pain. 1
Pain Characteristics Assessment
Pain History
- Onset and duration: When did the pain start? Was there a triggering event?
- Intensity and character: Use validated tools like:
- Location and radiation: Specific body regions affected and pattern of radiation
- Temporal pattern: Constant, intermittent, fluctuating
- Exacerbating and alleviating factors: What makes pain better or worse?
- Past and current treatments: Previous medications, procedures, therapies and their effectiveness 1
Red Flag Assessment
Be vigilant for signs suggesting serious underlying conditions:
- Fever
- Unexplained weight loss
- Severe pain unresponsive to standard measures
- Neurological deficits
- Signs of infection
- Pain that wakes patient from sleep
- New onset pain in elderly patients 1
Physical Examination
- Vital signs: Including pain at rest and during movement
- Examination of painful areas: Note tenderness, swelling, deformity
- Neurological assessment: Motor strength, sensory testing, reflexes
- Musculoskeletal examination: Range of motion, joint stability
- Abdominal examination: When indicated 1
Psychosocial Evaluation
- Mood assessment: Screen for anxiety and depression (67% of chronic pain patients report these conditions) 3
- Risk stratification: Use tools like STarTBack questionnaire for back pain to categorize patients into high, medium, and low risk of chronic disability 1
- Impact assessment: Effects on:
- Substance use history: Including prescription medications, alcohol, and recreational drugs
Diagnostic Workup
- Start with simple tests based on clinical suspicion:
- Avoid excessive testing and the continuous cycle of investigations 3
Risk Assessment for Chronic Pain
- Identify patients at high risk of developing chronic pain and disability:
- Early identification of high-risk patients allows for more intensive management, better resource allocation, and improved outcomes 3
Treatment Planning
- Develop a comprehensive pain management plan with the patient that includes:
- Specific functional goals
- Pharmacological approaches appropriate to pain type (nociceptive vs. neuropathic)
- Non-pharmacological approaches
- Patient education and self-management strategies 1
- Document baseline pain intensity, quality of life metrics, and treatment adherence 1
- Schedule regular follow-up assessments and plan to review the management plan within 6 months 3, 1
Special Considerations
- Opioid risk assessment: Implement a "universal precautions" approach for patients who may receive opioids, including abuse risk assessment and deterrence strategies 2
- Neuropathic pain: May require specific assessment tools and different treatment approaches (e.g., anticonvulsants, antidepressants) 4
- Cognitive impairment: May require alternative assessment approaches and collateral history 5
Documentation Requirements
- Complete pain assessment using structured format
- Treatment plan with clear goals
- Risk stratification results
- Patient education provided
- Follow-up plan and timeline
By implementing this comprehensive assessment framework, you can effectively evaluate new pain management patients and develop appropriate treatment strategies that address both the physical and psychosocial aspects of their pain.