Assessment of patients with chronic pain

How we think about pain influences the way in which we go about evaluating patients

E.J. Dansie; D.C. Turk

2013

Scholarcy highlights

  • How we think about pain influences the way in which we go about evaluating patients
  • In the absence of identifiable organic pathology, the healthcare provider may assume that the report of symptoms stems from psychological factors and may request a psychological evaluation to detect the emotional factors underlying the patient’s report
  • The patient’s history and physical examination remain the basis of medical diagnosis, can provide a safeguard against over-interpreting findings from diagnostic imaging that are largely confirmatory, and can be used to guide the direction of further evaluation efforts. In addition to this standard medical evaluation approach, an appropriate patient assessment requires an evaluation of the myriad psychosocial and behavioural factors that influence the subjective report of the characteristics of the pain, which can be done through interviewing
  • The Beck Depression Inventory and the Profile of Mood States are psychometrically sound for assessing symptoms of depressed mood, emotional distress, and mood disturbance, and have been recommended to be used in all clinical trials of chronic pain; the scores must be interpreted with caution and the criteria for levels of emotional distress may need to be modified to prevent false positives
  • Successful treatment of patients with chronic pain can only be accomplished if our assessment efforts focus on the entire person, not just the organic pathology
  • We can only highlight the components of such an assessment; more detail is available in a recent volume

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