1. Pain Management Tools

2. Assessment

3. 3 Pain Diagram

4. The information presented here is taken entirely, without any content modification from: Kendall, N A S, Linton, S J & Main, C J (1997). Guide to Assessing Psycho-social Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Accident Compensation Corporation and the New Zealand Guidelines Group, Wellington, New Zealand. (Oct, 2004 Edition). Suggested steps to better early behavioral management of low back pain problems Psychosocial Yellow Flags: Helping Someone at Risk

5. Red Flags Possible fracture Possible tumour or infection Possible significant neurological deficit From history Major trauma Minor trauma in elderly or osteoporotic Age >50 or <20 years History of cancer Constitutional symptoms (fever, chills, weight loss) Recent bacterial infection IV drug use Immunosuppression Pain worsening at night or when supine Severe or progressive sensory alteration or weakness Bladder or bowel dysfunction From physical examination Evidence of neurological deficit (in legs or perineum in the case of low back pain)

6. 6 PHQ-9

7. 7 GAD-7

8. Pain Catastrophizing Scale. RATING 0 1 2 3 4 MEANING Not at all To a slight To a moderate To a great All the degree degree degree time StatementRating 1I worry all the time about whether the pain will end 2I feel I can’t go on 3It’s terrible and I think it’s never going to get any better 4It’s awful and I feel that it overwhelms me. 5I feel I can’t stand it anymore 6I become afraid that the pain will get worse. 7I keep thinking of other painful events 8I anxiously want the pain to go away 9I can’t seem to keep it out of my mind 10I keep thinking about how much it hurts 11I keep thinking about how badly I want the pain to stop 12There’s nothing I can do to reduce the intensity of the pain 13I wonder whether something serious may happen The Pain Catastrophizing Scale: Development and Validation, Michael J. L. Sullivan, Scott R. Bishop and Jayne Pivik, Psychological Assessment, 1995, Vol. 7, No. 4, 524-532

9. 9 DN4

11. 11 Goals Decided with Patient: 1. 2. 3. 4. 5. 6. 7.

13. 13  Osteoarthritis  Rheumatoid arthritis  Neuropathic pain  Mixed nociceptive and neuropathic states Limited evidence or no efficacy in:  Fibromyalgia  Headache disorders Conditions Opioids Have Efficacy In: 13

20. 20 Algorithm