Pain & Disability Assessment Tools

Pain & Disability Assessment Tools

Pain scales and checklists offered in this section are useful for clinically assessing how intensely patients are feeling pain and for monitoring the effectiveness of treatments at different points in time. These essential tools for pain management practice are variously designed for different age groups, as well as individuals who do not speak English and/or cannot verbalize responses.

For additional documents discussing pain assessment in general see the Guidelines section
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Pain-Assessment & Monitoring Tools

From: Partners Against Pain®. Reviewed 2011.

This collection contains a number of helpful forms and assessment tools that can be downloaded and used to record pain intensity and duration, patient consent and treatment, clinical follow-up, and patient response to pain treatment. This website and associated contents are provided courtesy of Purdue Pharma, LP. Among others, the following may be of special interest to healthcare providers…

Reviewer: Stewart B. Leavitt, MA, PhD. Access to all checked July 15, 2011.

Access all of the following tools at:

http://www.partnersagainstpain.com/hcp/pain-assessment/tools.aspx

Pain Assessment Scales
> Visual Analog Scales (VAS)
> Numeric Pain Intensity Scale
> Simple Descriptive Pain Intensity Scale
> Graphic Rating Scale
> Verbal Rating Scale
> Pain Faces Scale
> Numeric Pain Intensity & Pain Distress Scales
> Brief Pain Inventory

> Memorial Pain Assessment Card (from Memorial Sloan-Kettering Cancer Center)

Patient-Assessment Forms
> Checklist for Long-term Opioid Therapy
> Initial Pain Assessment Tool
> Patient History

Clinical Follow-up Forms
> Follow-up Office Visit for Chronic Opioid Analgesia
> Opioid Progress Report
> Functional Progress Form

Pain Diaries & Reporting Forms for Patients
> Keeping a Pain Diary
> Records for Keeping Track of Your Care
> Pain Management Log
> Daily Pain Diary
> My Pain Diary

Drug Abuse Screening / Aberrant Behaviors Assessment

> Screening Techniques
> CAGE Questionnaire
> Brief MAST
> Opioid Risk Tool (ORT)
> Addiction Behaviors Checklist

Pain Assessment in the Patient Unable to Self-Report

From: American Society for Pain Management Nursing [Pain Management Nursing. 2011(Dec);12(4):230-250].

PDF available for download at: http://www.aspmn.org/Organization/…/UPDATED_NonverbalRevisionFinalWEB.pdf

This 25-page paper, plus extensive tables and references, replaces an earlier version from 2006. It defines populations at risk and offers clinical practice recommendations for pain assessment in those unable to self-report, including children and adults with cognitive impairments or other conditions limiting verbal communication.

Reviewer: Stewart B. Leavitt, MA, PhD. Access checked January 28, 2012.

Verbal Descriptor Scale (Pain Thermometer)

From: GeriatricPain.org; Center for Nursing Excellence in Long-Term Care.
This pain assessment tool may provide advantages when assessing patients who have communication challenges or diminished cognitive abilities. Access checked 7/15/2011.

Go to: http://www.geriatricpain.org/Content/Assessment/Intact/Documents/VDS_Thermometer.pdf

New Developments in the Diagnosis of Fibromyalgia Syndrome: Say Goodbye to Tender Points?

By: Wilke WS. Cleveland Clinic J Med. 2009:76(6):345-352. Access checked 7/3/09.

PDF available at: http://www.ccjm.org/content/76/6/345.full.pdf

This paper describes a relatively new diagnostic tool, the Symptom Intensity Scale, which assesses both regional pain and fatigue, and can be used in daily practice to establish a diagnosis of fibromyalgia syndrome and to measure its severity without the need to count tender points. It also can be used to detect fibromyalgia as a comorbidity in other clinical illnesses, and it correlates strongly with measures of depression and general health. The Symptom Intensity Scale questionnaire consists of two parts: a list of 19 anatomic areas in which the patient indicates if he/she feels pain (the total number of “yes” answers being the Regional Pain Scale score), and this is combined with the score on a 10 cm. visual analogue scale for assessing fatigue.

Reviewers: Stewart B. Leavitt, MA, PhD; Winnie Dawson, MA, RN, BSN. Access checked July 3, 2009.

Tools for Assessing Neuropathic Pain

By: Giorgio Cruccu, Andrea Truini; PLoS Medicine; 2009;6(4).

Available at: http://www.plosmedicine.org/article/info..

Neuropathic pain — arising from a lesion or disease affecting the somatosensory system — is a complex experience that also involves cognitive, emotional, and other influences. Hence there is a need for tools that can measure such pain objectively. This article distinguishes and discusses four different levels of evaluation: (1) laboratory tests that use quantitative tools and measure an objective response; (2) quantitative sensory testing, which inevitably relies on the patient’s evaluation; (3) bedside examination, which relies on the physician’s experience and the patient’s ability and willingness to collaborate; and (4) pain questionnaires, that depend entirely on patient perceptions.

Reviewer: Stewart B. Leavitt, MA, PhD. Access checked June 26, 2009.

DASH – Disabilities of the Arm, Shoulder, & Hand – Outcome Measure

From: Institute for Work & Health (IWH), Toronto, Ontario, Canada. Reviewed December 2008.

See: http://www.dash.iwh.on.ca/

This extensive website from the Institute for Work & Health (IWH), Toronto, Ontario, Canada (an independent, not-for-profit organization) features the DASH Outcome Measure. This is a 30-item, self-report questionnaire designed to assess physical function and symptoms in people with any of several musculoskeletal disorders of the upper limb. The questionnaire is available in multiple languages, and a shorter version called the QuickDASH is also presented. These tools are valid, reliable, and responsive; however, because the full DASH Outcome Measure provides greater precision, it may be the best choice for clinicians wanting to monitor arm pain and function in individual patients.

Reviewer: Stewart B. Leavitt, MA, PhD. Access checked April 28, 2009.

Assessing Obstructive Sleep Apnea Potential, Which May Affect Opioid Risk (Snore Score)

From: American Sleep Apnea Association.

PDF available at: http://www.sleepapnea.org/resources/…/snorescore

Patients with untreated obstructive sleep apnea (OSA) stop breathing repeatedly during sleep, sometimes hundreds of times during the night and often for a minute or longer. Besides other concerns with this disorder, persons with OSA who are prescribed opioid analgesics may be at particular risk of respiratory depression and fatal asphyxia. This quick, 6-item questionnaire – the Snore Score — can help detect patients who have or are at risk for OSA, and thereby help guide better informed opioid-prescribing decisions.

Reviewer: Stewart B. Leavitt, MA, PhD. Access checked July 25, 2011.

Pain Intensity Scales Used by the National Institutes of Health

From: NIH Pain Consortium. Reviewed 2007.

See: http://painconsortium.nih.gov/pain_scales/

These 5 pain intensity scales are commonly used for adults and children by researchers at the NIH Clinical Center. In addition, a checklist of nonverbal indicators is used to assess pain intensity in patients who are unable to communicate verbally.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked April 28, 2009.

Pain Rating Scales For Children

From: Texas Children’s Cancer Center.

See: http://www.childcancerpain.org/content.cfm?content=assess07

In addition to 3 assessment tools for children and infants, 5 additional methods are described for various assessment needs. A guide to effective questioning for pain evaluation during a history and physical is presented; and, additionally, the key elements in the use of behavioral observations and physical measures of pain are discussed.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked April 28, 2009.

Faces Scales for the Self-Report of Pain Intensity (Multi-Language)

These sites provide links for two widely-used faces scale. One is the Faces Pain Scale-Revised (FPS-R), available in 38 languages besides English. The other is the Wong-Baker FACES Pain Rating Scale, available in 10 languages besides English. Both have 6 faces, scored 0-2-4-6-8-10. An accompanying script can be read by anyone capable of communicating the language to a child and others for whom the scale is appropriate. It may be beneficial to print a copy of the most frequently used faces scales and scripts for quick access at the nurse’s station.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked December 8, 2011.
Additional review by Carl L von Baeyer, PhD, December 21, 2011.

Faces Pain Scale-Revised (FPS-R) from the International Association for the Study of Pain (in English and 38 other languages).
See: http://www.iasp-pain.org/FPSR

Wong-Baker FACES Pain Rating Scale (FACES) from Wong on Web Archive (English and 10 other languages).

See: http://www1.us.elsevierhealth.com/FACES/faces47translations.html

Multi-Language NUMERICAL Pain Rating Scales

The pain assessment tool provided by the British Pain Society is a 6-question instrument using a 0-10 numerical scale and it is available in 16 languages. The PartnersAgainstPain.com website provides one single question in multiple languages – ‘Please point to the number that best describes your pain.’

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked September 25, 2011.

From: The British Pain Society (Scroll to the bottom of the web page for 16 language options and select the appropriate language to download a PDF of the scale).

See: http://www.britishpainsociety.org/pub_pain_scales.htm

From: PartnersAgainstPain.com (instructions and one level-of-pain question in multiple languages).
Download PDF at: http://www.partnersagainstpain.com/printouts/Multilingual_Pain_Scale.pdf

The Assessment of Pain in Older People

From: Royal College of Physicians of London. October 2007.

Download PDF at: http://britishpainsociety.org/book_pain_older_people.pdf

This concise, 17-page guideline was developed in conjunction with the Royal College of Physicians, the British Pain Society, and the British Geriatrics Society. They reviewed current evidence in the literature to produce sound guidance for all practitioners in assessing the presence of pain in the elderly. Numerous pain rating scales and other tools especially applicable to this population of patients are provided.

Reviewer: Stewart B. Leavitt, MA, PhD. Access checked April 28, 2009.

Assessing Pain in Older Adults With Dementia

From: John A. Hartford Institute for Geriatric Nursing and the Alzheimer’s Association. Revised 2007.

Download PDF at: http://consultgerirn.org/uploads/File/trythis/assessingPain.pdf

This 2-page best-practice publication discusses issues related to effective pain assessment in the patient with advanced dementia and provides an assessment tool. The Pain Assessment in Advanced Dementia Scale (PAINAD) is a 5-item observational tool that is easy to implement — detailed descriptions of relevant patient characteristics in each category are provided to aid the scoring process.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked April 28, 2009.

Neuropathic Pain Scale

From: PainEdu.com. 2006.

PDF available for download at: http://www.painedu.org/Downloads/tools/ NeuropathyPainScale.pdf

Scale first created by Drs. Galer and Jensen (1997), provides a 10 question survey specifically assessing neuropathic pain in terms of essential qualities, such as intensity, heat, sharpness, sensitivity, and others.

Reviewer: Stewart B. Leavitt, MA, PhD. Access checked November 21, 2010.

Pain, Suffering, and Spiritual Assessment

From: City of Hope. 2006.

Download PDF at: http://prc.coh.org/pdf/Suffering-FF%2011-06.pdf

This 1-page assessment provides 18 questions as a discussion guide to help the patient identify personal emotional and spiritual attitudes as they relate to pain and suffering. While this tool would be very beneficial in a palliative-care setting, it could be utilized in any situation where a patient experiencing chronic pain could benefit from a reminder or an examination of their spiritual beliefs.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked April 28, 2009.

Pain Drawing

From: American Academy of Physical Medicine and Rehabilitation. 2001.

Download PDF at: http://www.aapmr.org/patients/conditions/pain/Documents/paindrawing.pdf

This 1-page anatomical diagram is a communication tool that helps patients show healthcare providers each area of their discomfort. Brief instructions guide the patient to mark each painful location with a symbol according to symptom type (e.g. xxx’s for burning pain, ===’s for numbness, etc.).

Reviewers: Winnie Dawson, MA, RN, BSN, SB. Leavitt, PhD.. Access checked February 28, 2011.

Migraine Disability Assessment Test (MIDAS and PedMIDAS)

The MIDAS and PedMIDAS forms were designed to measure the impact of headaches on a patient’s life during the previous 3 month period. It is a self-administered, easy-to-use tool for communicating with healthcare providers. The adult form explores the affect of chronic migraines on work, family, and social activities; the PedMIDAS form for children and adolescents asks questions regarding the impact on school performance and participation in family and social commitments.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked May 4, 2009.

From: University of California, Berkeley (adult 1-page printable PDF). 1997.
Download PDF at: http://uhs.berkeley.edu/home/healthtopics/pdf/assessment.pdf

From: Cincinnati Children’s Hospital Medical Center (pediatric 1-page printable PDF). 2001.
Download PDF at: http://www.cincinnatichildrens.org/svc/alpha/h/headache/pedmidas.htm

Aberdeen Low Back Pain Scale

From: Provided by the Centre for Evidence Based Physiotherapy in the Netherlands; developed by researchers from the University of Aberdeen and the Aberdeen Royal Infirmary of Scotland. 1994.
Original reference source: Ruta DA Garratt AM et al. Developing a valid and reliable measure of health outcome for patients with low back pain. Spine. 1994;19:1887-1896.

Download PDF at: http://www.cebp.nl/vault_public/filesystem/?ID=1208

This self-administered patient low back pain scoring tool can be used in an initial evaluation and during a follow-up assessment to monitor treatment effectiveness. It is a disease-specific tool consisting of 19 pain-related questions including: analgesia use, aggravating factors, distribution of symptoms, and the effect of pain on physical functionality. Possible scores range from 0 – 100; some scoring information is included.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked May 4, 2009.

Dallas Pain Questionnaire

From: Osteoarthritis Research Society International; Colorado Rehabilitation & Occupational Medicine.
Original reference source: Lawlis F, Cuencas R, Selby D, McCoy C. The development of the Dallas Pain Questionnaire: An assessment of the impact of spinal pain on behaviour. Spine. 1989;14(5):511-516.

Download PDF at: http://www.oarsi.org/pdfs/pain_indexes/Dallas_Pain_Questionnaire.pdf

Patients with chronic pain complete this 16-item questionnaire to provide information on their functional activity and emotional status. This tool was developed from a cognitive behavioral perspective and evaluates 4 aspects of patient’s lives: 1) daily activities such as walking, sitting, standing; 2) work and leisure; 3) anxiety and mood; and 4) social interest and interpersonal skills. Each item is scored on a visual analogue scale measured from 0-100%.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked May 4, 2009.

Sheehan Disability Scale

From: Center for Quality Assessment & Improvement in Mental Health; Developed by David V. Sheehan, 1983.
Original reference source: Lawlis F, Cuencas R, Selby D, McCoy C. The development of the Dallas Pain Questionnaire: An assessment of the impact of spinal pain on behaviour. Spine. 1989;14(5):511-516.

Download PDF at: http://www.cqaimh.org/pdf/tool_lof_sds.pdf

This 1-page assessment provides an opportunity for the patient to communicate their perceived level of disability due to symptoms (including pain) using 5 self-report questions. The form can easily be administered during a physician visit and provides information on the extent to which a patient’s symptoms interfere in 3 areas of life: work or school, social activities, and home life. Instructions for use and scoring techniques are included.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked May 4, 2009.

Psychosocial Pain Assessment

From: City of Hope.

Download PDF at: http://prc.coh.org/pdf/Psychosocial%20Pain%20Assessment%20Form.pdf

This 7-page interview form provides questions that can guide an interviewer through an evaluation of the impact of pain in 5 areas of a patient’s life – economic, social support, activities of daily living, emotional, and coping behaviors – as perceived by the interviewer, patient, and significant other. The completed assessment can provide valuable information for each of the patient’s caregivers, but evaluation by a social worker may provide the most comprehensive appraisal of the overall impact of pain on the patient’s life.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked April 28, 2009.

Brief Pain Inventory (BPI)

The Brief Pain Inventory (BPI) is commonly used in clinical research to assess the severity of pain and the impact of pain on daily functions. This tool has demonstrated consistent reliability in both the short (9 questions) and the long form (32 questions). It can be used in clinical practice for assessment and/or comparative analyses of outcomes in similar populations as presented in published literature.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked May 16, 2009.

From: MD Anderson Cancer Center (2-page short form).
Download PDF at: http://www3.mdanderson.org/depts/prg/bpisf.pdf

From: MD Anderson Cancer Center (6-page long form).
Download PDF at: http://www3.mdanderson.org/depts/prg/bpilong.pdf

Neck Pain Disability Index Questionnaire

From: Osteoarthritis Research Society International.

Download PDF at: http://www.oarsi.org/pdfs/pain_indexes/NECK_PAIN_DISABILITY_INDEX_QUESTIONNAIRE.pdf

Patients with neck pain, including the pain of osteoarthritis, can complete this 10-item survey to report the degree to which pain has affected their ability to manage activities of daily living. The design of the questions aids in the assessment of pain intensity, the affect of pain on functionality, and the presence of emotional factors. Scoring information is included and the instructions suggest that this questionnaire should take about 5 minutes for a patient to complete.

Reviewer: Winnie Dawson, MA, RN, BSN. Access checked May 4, 2009.

Special Clinical Tools for Assessing Opioid Risks

Apart from tools for evaluating pain, other properly validated and applied tools can help in assessing current or potential risks of drug abuse, misuse, addiction, or diversion associated with prescribed opioid analgesics.

Go to the opioid risk assessment tools section…>