This or other numeric pain scales may be particularly useful for assessing pain in patients who have language deficits or other issues with communicating their experience of pain. The PEG scale can be very useful in primary care or busy practices to assess pain, functioning, and quality of life. Self-Assessment Question 7 Which tool is an example of a numeric pain scale? a. The Brief Pain Inventory (BPI) b. The McGill Pain Questionnaire (MPQ) c. The Pain, Enjoyment of Life, and General Activity Scale (PEG) d. The Visual Analogue Scale (VAS) The correct answer is d. Rationale : The Visual Analogue Scale (VAS) is an example of a numeric pain scale. BEFORE MOVING ONTO THE NEXT SECTION, PLEASE COMPLETE CASE STUDY 1. Assessing Mental Health Screening tools to assess patients with pain for mental health disorders ahead of prescribing opioids include: • Patient Health Questionnaire-2 (PHQ-2), a two-item screen for depressive disorder that leads to more detailed assessment if either item is positive. 109 The PHQ-2 is available at the following link: https://www.hiv.uw.edu/ page/mental-health-screening/phq-2 • Patient Health Questionnaire-9 (PHQ-9), this nine-item screen for depressive disorder may be used initially or as a follow-up to the PHQ-2. 110 This tool and its variations are brief, reliable, valid, and easy to score.
Figure 3. The Defense and Veterans Pain Rating Scale and Supplemental Questions
Instructions: Spend 5-10 minutes reviewing the case below and considering the questions that follow. Case Study 1
Peter is a 70-year-old who presented to the emergency department almost a year ago with new onset of painful rash to the right thorax. He described the pain as 9-10 with a sharp, shooting type sensation. He was subsequently diagnosed with herpes zoster. He was admitted and placed in isolation. He received treatment and spent 6 days in hospital before being discharged. About 6 months ago he saw his primary care physician (PCP) for persistent burning pain in the same area. His PCP explained to him that he had post herpetic neuralgia and prescribed treatment. He returns to the clinic today with similar complaints and is asking about alternative treatments for the pain.
1. What are the subdivisions of chronic neuropathic pain?
2. Which noninvasive, nonpharmacologic approaches to pain management would you discuss with this patient?
3. Which steps can be taken to address the possible barriers to effective pain care?
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