September 14, 2022
2 minutes to read
Source / Disclosures
Clark MR. Chronic pain assessment. Filed At: PAINWeek; Las vigas; September 6-9, 2022.
Clark does not report any relevant financial disclosures.
A presenter at PAINWeek 2022 said that chronic pain is not a direct disease, and a clinician should gather information from a variety of sources.
“We don’t get a strong set of training to deal with patients like this,” Michael R. Clark, MD, Master of Public Health, Master of Business Administration, Professor of Psychiatry and Behavioral Sciences in the George Washington University School of Medicine and Health Sciences. “Although chronic pain is a disease, it is different from high blood pressure, cancer and diabetes in that we understand a certain chain of causes and consequences. We have to think about what makes these patients so great and difficult. It is not a straightforward disease.”
Clark advised first determining whether you are treating chronic pain or treating chronic pain from a specific type of pathophysiological disorder and related consequences.
“Talk to patients; extract from them what they went through, what they did and benefited from, and what didn’t work.” Ask about other sources of information – a family member, another doctor, old records, required tests. Use questionnaires. Find out what’s causing them pain.”
Functional evaluation is important to determine what the patient can or cannot do and whether or not it is due to pain or something else.
Clarke said he found out the extent of the patient’s suffering through psychological evaluation.
“A lot of medications are prescribed in this area, so it’s important to know what people have taken, who prescribed it, and for how long,” he said. This population tends to eat the over-the-counter stuff and pursue all sorts of other treatments. You must be aware of what they are doing. You likely won’t get rid of them with every substance they ingest.”
He said remembering HAMSTER pneumonic to help build a treatment plan: history, assessment, mechanism (pain), social factors (and psychological factors), treatment, education, and reassessment.
Clark said patients’ prior tools for assessing pain are not helpful.
“It’s impossible to ask someone to rate their pain,” he said. “These tools were an early attempt to legitimize and objectiveize pain.”
Psychological questions are important for determining your patient’s problems, what support they get and how they deal with them.
“Talk to them about what they are going through,” Clark said. “You’re just trying to walk in their place.”
He pointed out that “intimidation” can be reduced through a good relationship between the patient and the service provider.
Patients who avoid doing things that might hurt them suffer from animophobia.
“Convincing people of avoidance behavior is like dealing with a phobia,” Clark said. “You do it little by little. It’s all about managing anxiety, reducing it, and feeling mastered. People who are distressed, disabled, who don’t do well with their chronic pain feel incompetent. Our biggest fear is that they will develop a substance use disorder.”
There is no single diagnostic test for pain, Clark said. The use of imaging, neurophysiological tests, and laboratory studies can confirm underlying causes such as rheumatoid arthritis, diabetic neuropathy, spinal disorders, HIV, hepatitis C, herpes virus, vitamin deficiencies, autoimmune disorders, and malignancies.
Initial treatment should be individualized; Involvement of a multidisciplinary team may be graded; They include behavioral, non-pharmacological and pharmacological modalities; He added that it includes analgesics along with other complementary agents.
He noted that multiple tests may not be useful and could lead to false positives.
“The best source of data is old records from previous practitioners,” Clark said.
“Create a care plan based on your best formulation and what you believe are triggers for pain, and be prepared that patients don’t listen to you.”