TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER DEPARTMENT OF FAMILY & COMMUNITY MEDICINE
Behavioral Science Handbook for Family Medicine Pain Clinic Lance Evans, Ph.D. David R.M. Trotter, M.A. © Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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TABLE OF CONTENTS Introduction to Behavioral Science in Family Medicine Pain Clinic .............................................................. 3 Pain Clinic Behavioral Science Assessment ................................................................................................... 4
Basic Demographics, Lifestyle Issues, Stress & Coping .......................................................................... 4
Pain Assessment ..................................................................................................................................... 4
Disability & Functioning .......................................................................................................................... 4
Opioid Abuse .......................................................................................................................................... 4
Illness Behavior ....................................................................................................................................... 5
Depression, Anxiety, & Somatization ..................................................................................................... 5
Quality of Life ......................................................................................................................................... 5
Readiness to Adopt a Self‐Management Approach to Chronic Pain ...................................................... 5
References .................................................................................................................................................. 11 Pain Patient Personal Profile Example ........................................................................................................ 12 © Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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INTRODUCTION TO BEHAVIORAL SCIENCE IN FAMILY MEDICINE PAIN CLINIC As part of Office Month rotation, residents will participate (1‐3 times) in the Family Medicine Pain Clinic. Residents’ participation in this experience will be supervised by Drs. Whitham and Evans. Dr. Evans’ portion of this experience will primarily focus on psychosocial assessment and diagnostic issues, the doctor‐patient relationship, adherence, behavior change, somatic fixation, and difficult patient encounters. To facilitate this experience, Dr. Evans will conduct an assessment of the patient which will be collaboratively reviewed with Dr. Whitham and the resident. What follows is an explanation of the different types of psychosocial assessment Dr. Evans will provide, as well as their relevance to the treatment and management of chronic pain patients. Targeted Competencies: Patient Care, Medical Knowledge, Interpersonal & Communication Skills, Systems‐Based Practice Goals: This activity will enable residents to provide compassionate, appropriate, and effective patient care based on an integrative understanding of the patient; obtain knowledge of the social‐behavioral sciences (established and evolving), as well as the application of this knowledge to patient care; develop interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals; and develop an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Objectives: Residents will demonstrate a developmentally‐appropriate ability to gather essential and accurate biological, psychological, and social information from patients; formulate an integrative (bio‐ psycho‐social) assessment of patient; treat patients’ health problems and psychosocial or mental health conditions compassionately, appropriately, and effectively, based on an integrative understanding of patient; obtain and apply knowledge of the social‐behavioral sciences (established and evolving) to patient care; communicate effectively with patients and their families, across a broad range of socioeconomic and cultural backgrounds; communicate effectively with Behavioral Science faculty and staff; and work in inter‐professional healthcare teams to improve patient care quality. © Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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FAMILY MEDICINE PAIN CLINIC BEHAVIORAL SCIENCE ASSESSMENT Basic Demographics, Lifestyle Issues, Stress & Coping Rationale for assessment: Obtaining demographic, lifestyle, and stress and coping information will put the patient’s experience of pain in context. Demographic, lifestyle, and stress and coping information will be assessed by simple checklist and/or questionnaire. Information will include gender, age, ethnicity, disability status (including any legal action associated with obtaining disability status), pain medications, psychoactive medications, illicit drug use, addictions (e.g., smoking), psychosocial stressors, and coping behaviors. Pain Assessment Rationale for assessment: Subjective and objective measures of pain are necessary to determine the intensity of the patient’s experience of pain. Pain will be assessed subjectively using a visual analog pain rating scale (VAPRS).1 A VAPRS provides a measure of pain intensity along a numerical scale. Ratings are obtained for worst last week, least last week, on average, and right now. Scores are interpreted as mild, moderate, or severe. Pain will also be assessed objectively using a revised and shortened form of the McGill Pain Questionnaire (MPQ).2 The MPQ provides a measure of pain intensity along five (5) dimensions: continuous (e.g., throbbing, cramping), intermittent (e.g., shooting, stabbing), neuropathic (e.g., hot‐ burning, cold‐freezing), affective descriptors (e.g., tiring, sickening), and overall. Scores are either below average, average, or above average, when compared to other pain patients. Disability & Functioning Rationale for assessment: Assessing what impact the patient’s pain has on psychosocial and physical functioning is a key outcome measure. Disability and functioning will be assessed using the Pain Disability Questionnaire (PDQ).3 The PDQ measures disability and functioning for the full array of chronic disabling musculoskeletal disorders. Patients receive three (3) scores: general functioning, psychosocial functioning, and overall functioning. Scores on general functioning provide a measure of the patient’s physical functioning with respect to their chronic pain, while scores on psychosocial functioning provide a measure of the patient’s psychological and social functioning with respect to their chronic pain. Scores on overall functioning provide a measure of the patient’s combined physical and psychosocial functioning. Scores range from mild‐moderate‐severe‐extreme. Opioid Abuse Rationale for assessment: Because the medications used in the treatment of chronic pain can often be addictive, it is important to determine if the patient is at high risk for substance abuse. The potential for opioid abuse will be assessed using a short form version of the Screener and Opioid Assessment for Patients with Pain (SOAPP).4 Patient scores are categorized as either low risk or high risk. High risk scores suggest that a patient may have a substance abuse problem, and thus will need careful monitoring if opioids are used to treat their chronic pain. © Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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Illness Behavior Rationale for assessment: How a patient perceives, evaluates, and acts in relation to their pain is an important factor that influences the process and outcome of treatment. Illness behavior will be assessed using the Screener‐Illness Behavior Questionnaire (SIBQ).5 The SIBQ assesses for several behaviors that are likely to affect the treatment of chronic pain, as well as the relationship between doctor and patient. These behaviors include somatization, preoccupation with symptoms, and help‐rejecting behavior. Patient scores are categorized as either low, moderate, or high risk. Moderate‐High risk scores suggest that a patient may display some or all of the above behaviors. Depression, Anxiety, & Somatization Rationale for assessment: Because affect and psychological functioning can have a significant influence on the experience of pain, it is necessary to evaluate pain patients for depression, anxiety, and somatization. Depression, anxiety, and somatization will be assessed using the Pain Patient Profile (P3).6 The P3 provides a validity index, as well as scores on depression (e.g. sleep disturbance, psychomotor activity, hopelessness), anxiety (e.g., worry, nervousness, restlessness, and emotional instability), and somatization (concerns about pain, physical health, bodily processes, muscle tension, and physical abnormalities). Quality of Life Rationale for assessment: Assessing quality of life is a key outcome measure. Quality of life will be assessed using the Quality of Life Inventory (QOLI).7 The QOLI provides a measure of life satisfaction across 16 domains: health, self‐esteem, goals‐and‐values, money, work, play, learning, creativity, helping, love, friends, children, relatives, home, neighborhood, and community. Quality of life is categorized as Low, Very Low, Average, or High. Readiness to Adopt a Self‐Management Approach to Chronic Pain Rationale for assessment: Self‐management approaches to chronic pain (e.g., relaxation, breathing exercises, etc.) have demonstrated efficacy. However, many chronic pain patients are unaware of or not interested in these types of approaches, and/or would prefer a pharmacological approach only. This assessment will provide important clues as to the patient’s readiness to adopt a self‐management approach to chronic pain. Readiness to adopt a self‐management approach to chronic pain will be assessed using the Pain Stages of Change Questionnaire (PSOCQ).8 The PSOCQ scores patients as Pre‐Contemplation, Contemplation, or Preparation‐Action. By definition, adopting a self‐management approach to chronic pain involves exploration of the psychosocial aspects of pain. As such, readiness to adopt a self‐management approach to chronic pain is synonymous with the patient’s readiness to explore the psychosocial aspects of their pain. The stages, as well as interventions for each, are described below:9,10 © Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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Pre‐Contemplation Stage of Change Patients in the Pre‐Contemplation stage fall into four sub‐types (although there may be some overlap): Reluctant, Resigned, Rebellious, and Rationalizing. Reluctant or Resigned Pre‐Contemplation What to Expect: Little insight into the psychosocial aspects of their pain, hopeless about the prospect of change, passively resistant to change, slow to change. Action Script‐What to do Rationale “We have talked a lot about the physical aspects of your pain, I Providing patients with choice was wondering if we could also talk about other aspects of your Ask patient for facilitates openness and physical pain, like emotions and thoughts.” permission to commitment. discuss “If it is alright with you I would like to change gears slightly. I psychosocial Patients who choose a would like to discuss how thoughts and emotions affect the aspects of pain treatment are more likely to be experience of pain. Would you be interested in discussing that compliant. with me; I think you may find it helpful?” Distribute information on pain self‐management These patients need time to Gently “Plant a “connect the dots;” providing seed” Point out situations in their story where behavior and emotions info is a good way to help them affected their experience of pain, explore this with them. do that. Self‐efficacy is directly related Instill hope, and Highlight situations in the patent’s history when they successfully to change behavior. build on coped with pain. Use this as an example to build confidence. previous A little reassurance can go a successes Validate their adaptive efforts to control pain long way Express Use empathetic statements liberally: “It sounds like you have Good rapport increases empathy and really struggled with your pain”, and/or “I can see how that could compliance build rapport be very frustrating.” Empathy encourages openness Validation increases openness Validate their experiences when appropriate. Listen and and confidence provide caring Gently point out discrepancies feedback These patients are not likely to Listen to their concerns and respond respond well to confrontation
Rebellious Pre‐Contemplation What to Expect: Heavily invested in the treatments they are currently receiving (or would like to receive) and/or in their role as a pain patient. These patients will likely respond with anger and hostility, and will blame others (e.g. healthcare providers) for their ongoing experience of pain. Action Script‐What to do Rationale “We have talked a lot about the physical aspects of your pain, I Providing patients with choice was wondering if we could also talk about other aspects of your Ask patient for facilitates openness and physical pain, like emotions and thoughts.” permission to commitment. discuss “If it is alright with you I would like to change gears slightly. I psychosocial Patients who choose a would like to discuss how thoughts and emotions affect the aspects of pain treatment are more likely to be experience of pain. Would you be interested in discussing that we compliant. me, I think you may find it helpful?” Provide Provide an menu of options (e.g. several non‐opiate pain meds, These patients are heavily multiple physical therapy, behavioral management) invested in making their own options and let decisions. patient choose Encourage the pt to choose elements of their treatment © Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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Good rapport increases Use empathetic statements liberally: “It sounds like you have compliance and openness really struggled with your pain”, and/or “I can see how that could be very frustrating.” Express Empathy may decrease anger empathy and and blame. Let patient tell their story with minimal interruption build rapport Agree with the patient when appropriate: “You are right; it Agreeing with the patient can sounds like that situation was not handled as well as it could take the angry wind out of have been.” their sails. Arguments and confrontation What to avoid Do not argue or confront. will validate their anger and blame.
Rationalizing Pre‐Contemplation What to Expect: Will seem as though they “have it all figured out”, or that they “have all the answers” regarding their problems. They will likely want to engage in a debate over behavior change. Unlike Rebellious individuals, rationalizing individuals will not be overly emotional. Action Script‐What to do Rationale “We have talked a lot about the physical aspects of your pain, I Providing patients with choice was wondering if we could also talk about other aspects of your Ask patient for facilitates openness and physical pain, like emotions and thoughts.” permission to commitment. discuss “If it is alright with you I would like to change gears slightly. I psychosocial Patients who choose a would like to discuss how thoughts and emotions affect the aspects of pain treatment are more likely to be experience of pain. Would you be interested in discussing that we compliant. me, I think you may find it helpful?” As the patient to list the pros and cons of continuing their Patients spend more time current coping strategies for pain management (e.g. seeking defending cons than examining meds, avoiding activities). Perform a pros. Examining pros with decisional patient tells them that you are Begin with pros first balance 1) listening, 2) interested in exercise their problems, and 3) that you Reflect on pros and cons with the patient are non‐judgmental. These things increase openness. Focus more time on pros than cons Good rapport increases Express Use empathetic statements liberally: “It sounds like you have compliance empathy and really struggled with your pain”, and/or “I can see how that could build rapport be very frustrating.” Empathy encourages openness Rational debates are likely to Avoid rational debates with these patients. However, this can be validate the patient’s beliefs, What to avoid difficult as these patients will want to engage you in this type of regardless of how sound your exchange. arguments are.
© Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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Contemplation Stage of Change Contemplation What to Expect: Contemplators recognize that there may be some utility in self‐management of pain, but are ambivalent about adopting this style of pain management. They may, or may not be well informed about their options. They are likely open to considering change, but may be far from making a commitment. Action Script‐What to do Rationale “We have talked a lot about the physical aspects of your pain, I Providing patients with choice was wondering if we could also talk about other aspects of your Ask patient for facilitates openness and physical pain, like emotions and thoughts.” permission to commitment. discuss “If it is alright with you I would like to change gears slightly. I psychosocial Patients who choose a would like to discuss how thoughts and emotions affect the aspects of pain treatment are more likely to be experience of pain. Would you be interested in discussing that we compliant. me, I think you may find it helpful?” Encourage the patient to write down (or discuss) the pros and cons of engaging in their current pain‐management strategies. Patients in this stage tend to have roughly equal pros and Perform a It is helpful to begin with pros first cons. Helping them evaluate decisional them both sides equally can balance Spend time considering both sides create a platform from which exercise you can begin to shift the Encourage the patient to elaborate on elements of these lists balance. (e.g. Tell me more about this pro/con on our list) The goal here is to “tip” the balance towards change Encourage a Encourage patient to experiment with a brief behavioral pain trial management intervention (e.g. PMR, Imagery, Breathing A successful behavioral pain Exercises) management trial can move the patient toward change. Given patient’s history, select an intervention with a high probability of success. Good rapport increases Express Use empathetic statements liberally: “It sounds like you have compliance empathy and really struggled with your pain”, and/or “I can see how that could build rapport be very frustrating.” Empathy encourages openness
Preparation‐Action Stage of Change Contemplation What to Expect: Patients in the Preparation‐Action stage of change may still have some reservations in relation to change, but they are sufficiently motivated to attempt change. It is important that you capitalize on this motivation. Action Script‐What to do Rationale Briefly Describe the Pain‐Gate Theory of pain: “Pain is experience when Linking physical and emotional introduce the nerves in the body send pain signals to the brain. As these processes at a biological level provides a platform for you to rationale signals travel towards to the brain they enter the spine where introduce behavioral behind they meet other signals from the brain. These other signals, behavioral pain which are result of our thoughts and emotions, change the pain interventions without management signal, potentially intensifying or decreasing it. Therefore, having conveying the message that positive thoughts and emotions actually changes the experience the pain is “all in your head.” of pain at the cellular level. The exercises I am going to teach you © Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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will help you create the mindset that will hopefully make your pain more tolerable. Remember, I will be teaching you skills that take some time to learn. While you may experience some pain relief as you begin to learn these skills, continued practice is necessary to the maximize benefits.” Teach 1 Self‐ regulatory and See below 1 Self‐ management skill Express empathy and build rapport
Having a better understanding behind interventions can increase compliance and openness.
See below
Good rapport increases Use empathetic statements liberally: “It sounds like you have compliance really struggled with your pain”, and/or “I can see how that could be very frustrating.” Empathy encourages openness
Self‐Regulatory Skills Action Script‐What to do Progressive Muscle Provide patient with CD, and instruct use: “Progressive muscle relaxation, or PMR, is an Relaxation (PRM) exercise in which one’s attention is focused on reducing muscle tension. Reducing muscle tension can help some people reduce pain, and can help distract you from the pain when it becomes intense. PMR has been shown to be an effective pain management tool for people with many types of chronic pain. Please listen to the PMR track on this CD and follow the directions.” Negotiate frequency of use with patient; daily use is optimal but not always possible. Deep breathing Provide patient with CD, and instruct use: “Deep breathing is an exercise in which ones attention is focused on breathing. This type of exercise can help distract you from the pain when it becomes intents. Deep breathing has been shown to be an effective pain management tool for people with many types of chronic pain. Please listen to the deep breathing track on this CD and follow the directions.” Negotiate frequency of use with patient; daily use is optimal but not always possible. Imagery Provide patient with CD, and instruct use: “Imagery is an exercise in which ones attention is focused on an external image, preferably one that is relaxing. Imagery can help some people reduce pain, and can help distract you from the pain when it becomes intents. Imagery has been shown to be an effective pain management tool for people with many types of chronic pain. Please listen to the Imagery track on this CD and follow the directions.” Negotiate frequency of use with patient; daily use is optimal but not always possible.
Action Pacing
Planning/Time management
Self‐Management Skills Script‐What to do Slowly reintroduce physical activity and exercise to increase adaptive beliefs and self‐efficacy. Set goals for activity level which are reasonable, and unlikely to exacerbate pain experience. Instruct patients to engage in activities (e.g. mowing the lawn, doing laundry) they have been avoiding. However, instruct them to stop the activity well before it causes pain. For example, if a patient can mow the lawn for 30 minutes before it causes back pain, have them mow the lawn for 15 minutes. Inform patient that it is imperative that they discontinue these activities before they become “unbearably painful” and feel “overwhelmed.” Teach Goal Setting: Create a list of achievable goals, and steps to accomplish those goals. (e.g. Goal: Fix up yard, Step 1‐ Mow grass, 2‐ Edge grass, 3‐ Weed front flower bed, 4‐ Weed back flower bed, 5‐ Trim bushes, 6‐ etc . . . ) Teach patients (and model) how to create a prioritized To‐Do list. Start with the most
© Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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Problem Solving
important items scheduled during times of day where the patient’s energy is highest and their pain is the lowest. Three‐step problem solving. Use the following questions as a guide: 1) “What are you feeling?” (Help the patient label their reaction to the situation), 2) “What do you want?” (Helps them specify a goal), and 3) “What can you do about it?” (Focus on what can be done, and help the patient accept the things they cannot control). Practice this with the patient.
© Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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REFERENCES 1. McDowell I. Measuring Health: A Guide to Rating Scales and Questionnaires, 3rd ed. New York: Oxford University Press, 2006. 2. Dworkin RH, Turk DC, Revicki DA, et al. Development and initial validation of an expanded and revised version of the Short‐form McGill Pain Questionnaire (SF‐MPQ‐2). Pain. 2009;144(1‐2):35‐42. 3. Anagnostis C, Gatchel RJ, Mayer TG. The Pain Disability Questionnaire: A new psychometrically sound measure for chronic musculoskeletal disorders. Spine. 2004;29(20):2290‐2302. 4. Akbik H, Butler SF, Budman SH, Fernandez K, Katz NP, Jamison RN. Validation and clinical application of the Screener and Opioid Assessment for Pain Patients (SOAPP). Journal of Pain and Symptom Management. 2006;32(3):287‐293. 5. Chaturvedi SK, Bhandari S, Beena MB, Rao S. Screening for abnormal illness behavior. Psychopathology. 1996;29:325‐330. 6. Tollison CD, Langley JC. P3 Pain Patient Profile Manual. Minneapolis, MN: Pearson, 1995. 7. Frisch MB. Manual and Treatment Guide for the Quality of Life Inventory. Minneapolis, MN: Pearson, 1994. 8. Kerns RD, Rosenberg R, Jamison RN, Caudill MA, Haythornthwaite J. Readiness to adopt a self‐ management approach to chronic pain: The Pain Stages of Change Questionnaire (PSOCQ). Pain. 1997;72:227‐234. 9. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change, 2nd ed. New York: Guilford, 2002. 10. Gatchel RJ, Robinson RC. Pain management. In: O’Donohue W, Fisher JE, Hayes SC, eds. Cognitive Behavioral Therapy: Applying Empirically Supported Techniques in Your Practice. Hoboken, NJ: Wiley & Sons, 2003. © Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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Pain Clinic Personal Profile Date: Name: Gender: Age: Ethnicity: Disabled: Applying for Disability: Attorney, Legal Action: Pain Meds: Psy Meds: Illicit Drug Use: Other Addictions: Coping Behaviors: Stressors:
June 17, 2009 SJ Female 60 African American Yes No No Tramadol, Neurontin Wellbutrin, in the past Denied Tobacco Resting, sleeping, isolation, religion, meds $, family, health‐pain, disability
Subjective Report of Pain Intensity Pain (worst last week): Pain (least last week): Pain (average): Pain (right now):
7 7 7 7
out of 10 out of 10 out of 10 out of 10
Severe Pain Severe Pain Severe Pain Severe Pain
McGill Pain Questionnaire Continuous Pain: Intermittent Pain: Neuropathic Pain: Affective Descriptors: Overall Pain:
X 8.3 out of 10 0.7 out of 10 5.0 out of 10 8.5 out of 10 5.4 out of 10
T 61 34 53 61 52
Compared to Other Chronic Pain Patients Above Average Below Average Average Above Average Average
Pain Disability Questionnaire (General Functioning & Psychosocial Functioning) General Functioning: Psychosocial Functioning: Overall:
82 out of 90 48 out of 60 130 out of 150
Extreme Disability Extreme Disability Extreme Disability
© Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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SOAPP‐V1.0‐sf Abuse Risk Assessment:
5
out of 16
High Risk
SIBQ (Help‐Rejecting, Somatizing, Symptom‐Preoccupation) Risk Assessment:
4
out of 11
Low Risk
Readiness to Adopt a Self‐Management Approach to Chronic Pain Stage of Change:
Contemplation
P3: Pain Patient Profile Validity Index: Depression: Anxiety: Somatization:
9 57 48 62
out of 15 T‐Score T‐Score T‐Score
Valid Profile Severe Depression Mild‐Moderate Anxiety Severe Somatization
Quality of Life Inventory Overall Quality of Life Areas of Concern: Health Self‐Esteem Goals/Values Money Work Play Learning Creativity Helping Love Friends Children Relatives Home Neighborhood Community
32 ‐6 ‐2 ‐4 1 ‐1 1 ‐1 ‐4 ‐3 0 1 3 6 4 4 4
T‐Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score Raw Score
Very Low Area of Concern Area of Concern Area of Concern OK Area of Concern OK Area of Concern Area of Concern Area of Concern OK OK OK OK OK OK OK
© Lance Evans, Ph.D and David R.M. Trotter, M.A. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, redistributed, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 US Copyright Act, without prior written permission of the authors.
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