Screening questions for chronic pain

(Developed by Dr Chris Barker)

Question 1:

During the past month, has it often been too painful to do many of your day-to-day activities?

Question 2:

During the past month, has your pain been bad enough to often make you feel worried or low in mood?

It can be very difficult in the short consultation to identify when pain is a major problem. There are many people who suffer chronic pain who will not consult a GP, and will manage their pain independently. Equally, there are many who will require additional help, while those with severe acute pain will need care to minimise the risk of long-term chronicity.

The concept of acute or chronic pain is therefore not helpful in deciding who will need more input. Identifying those with problematic pain can be tricky. A useful starting point is to develop a working definition of ‘Problematic Pain’: Problematic pain can be thought of as severe pain associated with significant disability and/or distress.

It is widely know that persistent pain is associated with reduced quality of life, and causes distress and disability. Many studies have examined the prognostic factors involved in identifying those who are more likely to develop chronicity associated with their pain. The bullets below highlight the most frequently occurring prognostic factors from two systematic reviews.

  1. Depression
  2. Anxiety
  3. Higher pain intensity
  4. Longer pain duration
  5. Higher disability
  6. Multi-site pain
  • Pain cognitions (e.g. catastrophising)
  • Fear-avoidance beliefs
  • Self perceived poor health
  • Passive coping

The first six of these points represent very strong predictive value.

Utilising the evidence above, we can generate questions that can help identify those with problematic pain.

If ‘yes’ to either question, it will be necessary to take more care in the consultation to identify the impact pain has upon some of the important psychosocial factors. This can be done verbally or with evaluative tools such the Brief Pain Inventory. Other tools such as the STarT tool aim to stratify the risk into low, medium and high.

If the STarT tool is not in routine use, the two questions as above can help decide which patients may be appropriate to screen with STarT.


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