Assessment Tools and Clinical Guidelines

Assessment Tools

Brief Pain Inventory (Short Form) - BPI-SF (©World Health Organization)

The BPS-SF is a medical questionnaire used to measure pain, developed by the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care. Originally developed to assess cancer pain, the BPI has been validated for use in the chronic, nonmalignant pain population. It’s an important and widely used diagnostic tool for clinicians treating chronic pain.

CAGE: Alcohol Screen

The CAGE questionnaire has been extensively validated for use in identifying alcoholism and as a screening technique, with one study determining that CAGE test scores >=2 had a sensitivity of 93% and a specificity of 76% for the identification of problem drinkers. It’s not valid for diagnosing other substance abuse disorders, though modified versions of the CAGE are often used for these purposes.

Generalized Anxiety Disorder - GAD-7 (©Pfizer Pharmaceutical, 1999)

The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that has been proved valid as a measure of anxiety in the general population. Though designed primarily as a screening tool and severity measure for generalized anxiety disorder, the GAD-7 also has moderately good operating characteristics for three other common anxiety disorders: panic disorder, social anxiety disorder, and post-traumatic stress disorder.

Geriatric Depression Scale - GDS

The GDS is a self-report assessment based on 30 yes-or-no questions used to identify depression in the elderly. The simplicity of the test enables the scale to be used with ill or moderately cognitively impaired individuals. Although the test has well-established reliability and validity evaluated against other diagnostic criteria, responses should be considered along with results of a comprehensive diagnostic work-up.

Pain Anxiety Symptoms Scale - PASS-20

The PASS-20 consists of 20 items designed to assess four aspects of pain-related anxiety: cognitive anxiety, escape-avoidance behaviours, fear of pain, and physiological symptoms of anxiety. Research has shown a significant relationship between fear and avoidance of pain on the one hand, and the suffering and disability of chronic pain on the other. Effective measurement tools are critical to properly study this relationship.

Pain Catastrophizing Scale (PCS) (Michael J. L. Sullivan, Scott R. Bishop and Jayne Pivik, McGill University)

The PCS is a 13-item self-report scale to measure pain catastrophizing. The items are rated on a scale from 0-4 and have three different categories: rumination, magnification and helplessness.

Pain Outcomes Questionnaire - POQ  (Michael E. Clark, Ph.D. and Ronald J. Gironda, Ph.D., James A. Haley Veterans Affairs Hospital, Tampa, Florida)

The POQ is a multidimensional treatment outcomes measure consisting of 20 questions that assess specific aspects of pain syndromes. The POQ also provides six functional subcategories that may be of interest to clinicians: pain, mobility, self-care, vitality (energy), negative affect (mood), and fear of re-injury. 

Pain Treatment Agreement 

Doctors may require that patients sign a pain treatment agreement as a condition of their receiving therapy for chronic pain. These agreements are most commonly used when narcotic pain relievers are prescribed. The use of a Pain Treatment Agreement documents the understanding of how such narcotics are to be used. When used as a means of facilitating care, this type of document can improve communication between doctors and patients.

Patient Health Questionnaire - PHQ-9 (©Pfizer Pharmaceutical, 1999)

The PHQ-9 is a nine-item depression scale based directly on the diagnostic criteria for major depressive disorder in the DSM-IV. The PHQ-9 is a powerful tool for assisting primary care clinicians in diagnosing depression, as well as selecting and monitoring treatment.

The Tampa Scale of Kinesiophobia (TSK) (Miller, Kori and Todd, 1991)

The TSK is a 17-item scale originally developed to measure the fear of movement related to chronic lower back pain.

Clinical Guidelines

The following publications offer best practices and guidelines to anesthetists, doctors prescribing pharmaceuticals to the elderly, and nurses treating patients suffering from pain: