Understanding Arthritis
Pain Assessment
To assess your patient by using the "pain scales", please access via the "Pain Assessment" heading in the left hand menu bar on this link: www.PartnersAgainstPain.com
These recommendations are presented in abbreviated form. Readers should refer to the text of the guideline document1 for a detailed discussion of each of the following topics.
Definitions for the type of evidence (I, II, III, IV, V) and the strength and consistency of evidence grades (A, B, C, D, Panel consensus) are provided at the foot of this page.
Pain Assessment
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Treatment of people with arthritis should include, in addition to a complete history and physical examination, an initial comprehensive pain assessment and ongoing assessment of pain and functional status to identify, implement, and evaluate effectiveness of pain interventions. Pain assessment should focus on the type and quality of pain, source, intensity, location, duration/time course, pain affect, and effects on personal lifestyle. (Panel consensus)
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Self-report should be the primary source of pain assessment when possible. Behavioral observations and physiologic measurements may provide additional information but should not be used as the primary source of pain assessment. Exceptions are preverbal children and nonverbal and cognitively impaired individuals, for whom behavioral observation should be the primary source for pain assessment. (B)
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Selection of an appropriate pain assessment tool should take into consideration the person’s cognitive development, language, culture, and preferences. Use the same pain assessment tool for the person on subsequent assessments to facilitate reliable evaluations of changes in the pain. (B)
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Because pain is a major cause of disability in people with arthritis, assessment of functional status should be included in the pain assessment. When selecting a functional status measure, consideration should be given to the cognitive-developmental abilities of the person, the type of practice setting, the domains of function to be assessed, and the time and resources needed to complete the assessment. (B)
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When arthritis pain is persistent or severe, the clinician should conduct a comprehensive assessment, including an evaluation of biological, psychological, or social factors that may be contributing to pain as well as an assessment of the overall impact of pain on function. (Panel consensus)
Definitions
Type of Evidence
- Meta-analysis of multiple well-designed controlled studies.
- Well-designed experimental studies.
- Well-designed, quasi-experimental studies, such as nonrandomized controlled, single-group pre-post, cohort, time series, or matched-case controlled studies.
- Well-designed nonexperimental studies, such as comparative and correlational descriptive and case studies.
- Case reports and clinical examples.
Strength and Consistency of Evidence
- There is evidence of type I or consistent findings from multiple studies of types II, III, or IV.
- There is evidence of types II, III, or IV, and findings are generally consistent.
- There is evidence of types II, III, or IV, but findings are inconsistent.
- There is little or no evidence, or there is type V evidence only.
Panel Consensus: Practice recommended based on the opinions of experts in pain management.
References:
1. Available at: http://www.guidelines.gov/ and originally adapted from: Simon LS, Lipman AG, Jacox AK et al Pain in osteoarthritis, rheumatoid arthritis, and juvenile chronic arthritis.2nd ed. Glenview (IL): American Pain Society (APS); 2002. 179 p. (Clinical practice guideline; no. 2).