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Pain Evaluations

Pain Evaluations. Candace Barnacal, Kristen Dmytruk, Heather Lowe, Krista Mills, Victoria Morris, Beth Pyle, Emily Rodrigues. What is Pain?.

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Pain Evaluations

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  1. Pain Evaluations Candace Barnacal, Kristen Dmytruk, Heather Lowe, Krista Mills, Victoria Morris, Beth Pyle, Emily Rodrigues

  2. What is Pain? “Pain is a subjective experience that is generated by widespread, parallel neural networks in the brain on the basis of multiple inputs from sensory systems, as well as, from brain areas that underlie past experience, attention, evaluation, and meaning. Humans are fortunate to have language to express their pain.” - Ronald Melzack (designed the McGill Pain Questionnaire)

  3. Why Have Pain Evaluations? • These tests are easy to administer becuase they can be downloaded off the internet and most of them can be performed with out the help of a professional • These tests assess the type, quantity, intensity, and quality of an individuals pain to determine if they need surgery, a leave of absence from work, or an ergonomic evaluation

  4. Pain Drawings • Originally designed for patients with low back pain (lumbar) or patients being considered for surgery • Allows rapid assessment of subjective pain • Can assess similar patterns of pain through out the body • Get a better understanding of what kind of pain the patient is feeling and where they are feeling it

  5. Pain Drawings cont’d • It includes two diagrams of the human body: • one is anterior and the other posterior • Four different descriptors are given a specific symbol: === is for numbness OOO is for pins and needles XXX is for burning pain ///// is for stabbing pain • Patients place these symbols on the areas of the body where they are feeling them

  6. Pain Drawings cont’d • After the patient has filled out the form it is evaluated together by the patient and the practitioner and then the origins of pain are found on the patients body and discussed further

  7. McGill Pain Questionnaire • Originally designed by Ronald Melzack in the 1970’s • Used to determine the intensity and type of people’s pain, as well as, indicate the extent of change in pain quality and intensity after an intervention (rehab) • Melzack wanted to design a tool that was easy to use and that was reliable

  8. MPQ cont’d • The MPQ takes 5-10 minutes to administer • It consists of a list of word descriptors, which are usually put into three categories: sensory (i.e. throbbing or burning), affective (i.e. exhausting or punishing), and evaluative (i.e. annoying or intense) • Each descriptor is given a rank and the sum of these ranks produces the pain rating index (PRI)

  9. MPQ cont’d • There is also a present pain intensity (PPI) that is based on a scale of 0-5 • The number of words chosen to describe their pain is also taken into consideration • The patient can write down if their pain is external or internal plus any additional comments • There is also a short form of this questionnaire, which can be modified to fit individual needs i.e. answering for a specific part of the body, such as the pelvis

  10. To the left is the original MPQ and to the right is a short version that has been modified

  11. Visual Analogue Scale • This test is very simple and quick to administer • It measures a characteristic or attitude that is believed to range across a continuum – in this case it is pain • Since a patient’s pain can range from mild to severe and can change from day to day this tool is helpful to determine a pattern in that change

  12. VAS cont’d • A VAS consists of a line that is 100mm in length and at one end there is a description such as ‘No Pain’ and at the other end ‘Severe Pain’ • The patient is then asked to mark on the line where they feel would best represent their current pain • The score is determined by measuring in mm from the left end of the line to the point where the patient marked

  13. VAS cont’d • A lot of pain evaluations use discrete categorizations of pain such as; none, mild, moderate, or severe • However, most people’s pain does not jump from one category to the next, instead most patients feel their pain is continuous which is why having a continuum to rate pain allows for more accurate results • Other ways in which the VAS have been represented are by using vertical lines and extra descriptors • However, practitioners prefer to use scales that involve ranks (i.e. MPQ) because the VAS requires some interpretation by the practitioner which may be inaccurate

  14. Pain Rating Scale • There are many modifications to this test • Consists of making a scale, such as 0-10 with 0 being no pain and 10 being the worst pain ever • To help patients quantify their pain the practitioner can ask them to think of the worst pain they’ve ever been in and compare the present pain to that • Also, the patient should be asked if the pain rating changes with activity or certain movements • To function well, patients need to have a rating of 3 or less; ideally the patient should remain at a 2 as much as possible

  15. Pain Rating Scale cont’d • The purpose of this test is so the practitioner can better understand the patient’s level of pain and together they can set goals for pain relief

  16. Dallas Pain Questionnaire • The DPQ was developed to assess the amount of chronic spinal pain that affects daily and work activities, leisure activities, anxiety/depression, and social interests • It consists of a 16 item self-report that takes about 5 minutes to complete • Each item contains its own scale, which are divided into 5-8 small segments and the patient is asked to place an X to indicate where their pain falls on that scale

  17. DPQ cont’d • On the left side of the scale is a descriptor (i.e. no pain) and the value 0% and on the right side there is another descriptor (i.e. pain all the time) and the value 100% • This test allows the patient to measure pain on a continuum, which can also track changes in pain • Also, this questionnaire looks at the social factors of pain, such as how the individual’s pain affects relationships with others, as well as, controlling emotions and any anxiety or depression that may be caused by the pain

  18. DPQ cont’d • This test is unique because it takes into account social and emotional factors related to pain • Once these factors are determined the proper intervention strategies can be taken 

  19. Alternate Tests • The Brief Pain Inventory consists of • 9 questions with scales of 0-10 • A diagram so the patient can shade in areas of pain and place an X on areas of most pain • Questions ask about past, current, worst, and average pain, any treatment received for past pain, medication, as well as how much pain interferes with daily living

  20. Alternate Tests cont’d • The Standardized Nordic Questionnaire (SNQ) is designed for workers exposed to arm and hand vibrations (such as a chainsaw operator) • Prolonged exposure to arm-hand vibration can cause musculoskeletal disorders in the corresponding areas, such as weakness, pain or numbness • This test was developed by a team of Nordic researchers

  21. SNQ cont’d • The researchers created the SNQ so there was a simple standardized test available to screen musculoskeletal disorders, which could be used by companies who are hiring people who might be subject to arm-hand vibrations or those who have injuries and need to be assessed for any musculoskeletal disorders

  22. SNQ cont’d • The questionnaire consists of nine questions asking about any past or present pain or numbness in the body especially in the hands and feet, when in the year pain is most severe (spring, summer, fall, winter?), intensity of pain, how often pain occurs during the day/week • There are diagrams for the person to shade in the areas of most pain • Once the form is completed it is evaluated by a practitioner and the appropriate intervention strategies are taken

  23. Ergonomic Application • Jobs in a factory, or grocery store that may involve a lot of heavy lifting, pulling, pushing, or repetitive movements may cause pain or injury to an employee • These tests can be use to assess an individual’s pain level and then treatment/rehab can be performed, or an ergonomic assessment of the workplace can be done to determine if changes in the work environment or procedures need to be changed or improved • An ergonomic assessment can also get the approval for workers compensation and money grants for new equipment

  24. Final Thoughts • Since these tests use subjective assessment the practitioner has to rely on the individuals perception of their pain for an accurate diagnosis and treatment • Since everyone has a different tolerance of pain, the patient may provide exaggerated or understated reports of pain • However, these tests are very easy to administer and evaluate, they are quick, and can be modified to fit individual needs

  25. The End

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