1. Assessment and Measurement The effective Rx of Myofascial Pain begins with defining the Tissue and or Reflex that is maintaining the Pain State. Find the ‘Active Trigger Point’ Assess sympathetic involvement

2. Trigger Points Before being able to effectively treat (and evaluate that treatment’s efficacy) the Trigger Point must first be Identified! Quantified! Its associated reflexes delineated

3. Pain Assessment Tools Lord Kelvin 1824 -1907 “When you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, your knowledge is of a meager unsatisfactory kind: It may be the start of knowledge, but you have scarcely in your thoughts, advanced to the stage of science.”

4. Pain Assessment Tools “One of the most dramatic developments in pain research and therapy has been the recent proliferation of techniques for the measurement and assessment of Pain” R. Melzack

5. Pain Assessment Every patient complaining of chronic pain deserves to be examined. Palpation and the utilisation of pain assessment tools including: Pain Diagrams, the McGill Pain Questionnaire, Visual Analogue Pain Scale are all a necessary part of this process.( And should always be carried out before referral for psychologically based therapies.)

6. Pain Assessment Tools Rarely Used CMAE Pilot Study: 14 Australian GP’s 129 Pain Patient Consultations. Pain Diagram..............8% VAS............................. 9% McGill......................... 2% [ No Patient had all three tools, 2 had VAS plus the McGill Questionnaire]

7. Pain Assessment Tools Rarely Used Australian journal of Physiotherapy1996 The assessment of pain: an audit of physiotherapy practice. ( NE England) 921 cases, 21% were quantified in some way..... Only 2.5% of 723 who were re-evaluated following Rx had their pain quantified....

8. Myofascial Pain Syndrome Assessment- Tool Kit Subjective Visual Analogue Scale ( VAS ) McGill Pain Questionnaire Pain Diagram Objective Pressure Threshold Algometry Differential Local Anesthetic Blocks Thermography, EMG etc.

9. Visual Analogue Scale The VAS is a simple robust pain measurement tool It can be used to measure severity & or Improvement It can be reliably used for children over the age of five The VAS is usually designed as a 10cm line with descriptors at each end.

10. Visual Analogue Scale The VAS for Pain severity measurement No Pain Worst Possible Pain The VAS for Treatment Effect No Pain Complete Pain Relief

11. Visual Analogue Scale No Pain Worst Possible Pain The example shows a patient recording a 9.0 i.e. The patient has made a mark 9cms from the no pain end of the scale. NB The VAS can be compromised if descriptors or numbers are added between the end points. {The 10 cm line allows for easy measurement and recording}

12. The McGill Pain Questionnaire

13. The short form McGill Pain Questionnaire Sensory Dimension Affective D.

14. Pain Diagrams PAINDIAGRAMS

15. Myofascial Pain Syndrome Subjective Assessment Tool Kit Developed at the 10 High Street Pain Clinic. Please copy and use it