Overview
This segment by Mark Shepherd covers qualitative pain assessment tools, their uses, and how to match tools to patient needs, prognosis, and care planning.
Pain Intensity Scales
- Numeric Pain Rating Scale (NPRS): 0 = no pain; 10 = worst imaginable pain; common, verbal or written.
- Visual Analog Scale (VAS): patient marks pain intensity on a line; widely used in research.
- Wong-Baker Faces Scale: faces linked to pain ratings; useful for children and nonverbal or low-health-literacy patients.
- Instruction tip: define 0 as no pain and 10 as worst imaginable pain; avoid “ER-level pain” phrasing.
Pain Location and Quality Tools
- Pain drawing/body chart: patient marks areas with symbols (e.g., lightning for pins/needles, dots for numbness, hash marks for other descriptors).
- McGill Pain Questionnaire: descriptor-based, more time intensive; commonly used in research.
- Brief Pain Inventory (BPI): includes pain drawing; rates best, worst, and current pain; measures impact on mood and activity.
- Global Pain Scale: captures current, best, worst, and average pain; feelings about pain; clinical outcomes and activities.
Central Sensitization Assessment
- Central Sensitization Inventory (CSI): 0–100 score; higher = more sensitivity.
- Threshold: >40 suggests central sensitization; <40 helps rule out central sensitization.
- Use case: not routine; helpful when uncertain or for outcome-measure-driven care and quality improvement.
Risk Stratification for Persistent Pain
- Purpose: classify patients as low, medium, or high risk for persistent pain; informs prognosis and visit frequency.
- Low risk: fewer sessions may be needed; high risk: closer follow-up and more education.
Risk Stratification Tools
| Tool | Primary Population/Use | Notes on Validity/Scope |
|---|
| Start Back Screening Tool | Low back pain | Strong for low back pain; not broadly valid for other regions. |
| OMPQ (Ă–rebro Musculoskeletal Pain Questionnaire) | Musculoskeletal pain beyond low back | Better for various body regions with persistent pain risk. |
Yellow Flags and Psychosocial Measures
- Yellow flags: negative mood, anxiety, depression, fear avoidance, catastrophizing; impact prognosis and care.
Yellow Flag Screening Tools
| Tool | Focus | Items/Scoring | Use/Notes |
|---|
| OSPRO-YF (Optimal Screening for Prediction of Referral and Outcome—Yellow Flags) | Screens multiple yellow flags; estimates legacy scales | Concise single questionnaire | Efficient alternative to multiple separate questionnaires; predicts scores across 11 scales. |
| FABQ (Fear-Avoidance Beliefs Questionnaire) | Fear related to physical activity and work | 16 items; total 0–96; physical activity and work subscales | Tracks fear avoidance in activity/work contexts. |
| Pain Catastrophizing Scale (PCS) | Rumination, magnification, helplessness | 13 items; 0–52; cut score >30 indicates high catastrophizing | High scores linked to risk of persistent symptoms; track change with education. |
Knowledge Check (Answer Explanation)
- Best single tool to screen multiple yellow flags: OSPRO-YF.
- NPRS: intensity only; not for yellow flags.
- CSI: central sensitization screening, not broad yellow flags.
- FABQ: assesses fear only, not multiple domains.
Clinical Application and Prognosis
- Match tools to patient needs: intensity, location/quality, central sensitization, risk, and yellow flags.
- Risk tools guide session number and education intensity based on low/high risk.
- Use psychosocial measures to guide and monitor education targeting fear and catastrophizing.
Key Terms & Definitions
- NPRS: 0–10 numeric pain intensity scale.
- VAS: line-based visual pain intensity measure.
- Wong-Baker Faces: face-based pain scale for children/nonverbal.
- Pain drawing: body chart marking pain qualities and locations.
- CSI: 0–100 measure of central sensitization; >40 suggests central sensitization.
- Start Back: low back pain risk stratification tool.
- OMPQ: broad musculoskeletal risk stratification tool.
- OSPRO-YF: comprehensive yellow flag screening tool estimating legacy scales.
- FABQ: measures fear-avoidance in physical activity and work.
- PCS: measures catastrophizing; >30 indicates high catastrophizing.
Action Items / Next Steps
- Select pain intensity tool appropriate to patient (NPRS, VAS, Faces).
- Use pain drawing or descriptor-based tools when quality/location detail is needed.
- Administer CSI when central sensitization is suspected or for outcome monitoring.
- Apply Start Back or OMPQ for risk stratification to inform prognosis and visit planning.
- Screen psychosocial factors with OSPRO-YF; use FABQ and PCS to target and track education.