Screening Tool

Developing a pre-screening tool for problematic/complex pain has its roots in the work that has been undertaken in depression (Arroll et al 2003). In this context, if the clinician considers depression may be present yet undiagnosed s/he asks the patient two questions:

 

  • During the past month have you often been bothered by feeling down, depressed, or hopeless?
  • During the past month have you often been bothered by little interest or pleasure in doing things?

 

In this study if a positive response was gained to either, the patient then completed a validated diagnostic tool to establish whether depression was present. This initial two-question screening tool showed high sensitivity and moderate specificity (97% and 67% respectively) against the validated depression screening tool. For a short consultation however it could be that the real utility of such a brief tool is to decide whether or not it is necessary to further assess a clinical problem in more depth.

 

Anecdotal reports from primary care practitioners are that they do not have the time to screen all patients presenting with pain and yet are not sure when to introduce screening for those patients whose pain is not resolving. Therefore, developing a pre-screening tool for pain would address this, as it has in screening for depression.

 

If the data from studies to establish risk of pain chronicity are evaluated closely, a picture starts to emerge from those risks that are frequently shown. Two large studies have reviewed risk for chronicity in detail (Mallen et al 2007, Linton 2000), and when the outcomes are combined, five key factors show strong prognostic validity:

  • High pain intensity
  • Longer pain duration
  • High disability
  • Distress (depression, anxiety and catastrophising)
  • Multi-site pain

 

If problematic/complex pain is defined as ‘Any pain associated with, or with the potential to cause, significant disability and/or distress’, (defined at the initial scoping meeting), then when considering the outcomes bullet pointed above,  these risks may help to formulate the questions to be asked of patients.

 

The Tool

  • ‘Over the past two weeks has pain been bad enough to interfere with your day to day activities?’
  • ‘Over the past two weeks have you felt worried or low in mood because of this pain?’

 

Evaluating:

  • Pain duration                                       ‘..past two weeks..’
  • Pain intensity                                      ‘..pain been bad enough..’
  • Level of pain related disability           ‘..day-to-day activities..’        
  • Level of pain related distress              ‘..worried or low in mood..’   

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