Clinical Assessment & Patient Intake/Screening

what is viewed as the most effective approach currently?

biopsychosocial model

what should approach take into account?

individuals pain experience and complexity

skillful interview

aim questions to gain better understanding of patient’s experiences, suffering, beliefs

key issues from PNE perspective

create therapuetic alliance

screen patients

establish psychosocial barriers to improvement

assess pain mechanisms

red flags

looking for patterns to suggest viscerogenic or systemic origin

requires immediate attention (further screening or referral)

yellow flags

psychosocial barriers to recovery (fear, stress, etc)

potential to increase risk of long term disability and work loss

main contributors to pain and disability and have potential to increase risk of long term disability and work loss

outcome measures addressing yellow flags

fear avoidance belief questionnaire

pain catastrophization scale

tampa scale for kinesiophobia

PHQ 9

state trait anxiety inventory (STAI)

FABQ w

high score : >34

FABQpa

high score >15

catastrophizing

the inability to foresee anything other than the worst possible outcome, or experiencing a situation as unbearable or impossible when it is just uncomfortable

PCS

greater than or equal to 30 indicates clinically relevant level of catastrophizing

tampa scale for kinesiophobia

score >37 = fear of movement

PHQ-2 score

>2 = further evaluated with PHQ 9

PHQ-9 score

>10 indicates depression

self evaluation questionnaire score

>39-40 = clinically significant anxiety symptoms

older adults= score of 54-55

assessing pain mechanisms

way we assess pain can ignite neuromatrix

(widespread brain activity associated with pain experience)

criteria for CS pain

perceived pain/disability disproportionate to nature of injury/pathology AND

diffuse/neuro-anatomically ilogical distribution OR hypersensitivity present

widespread pain index

19 body regions

score of 7 or greater = widespread pain

central sensitivity inventory (CSI)

cutoff score of 40 indicates possibility of predominant CS pain