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Clinical Assessment Objectives for Pain Management

Purpose: To evaluate a patient undergoing rehabilitation with the need for ongoing pain management using the Clinical Assessment Objectives of Gottlieb et al.

Description

Gottlieb et al identified factors associated with successful pain management by a patient in rehabilitation for low back pain. This can help identify how motivated the patient is to do what it takes to manage pain. The authors are from the Casa Colina Hospital for Rehabilitative Medicine in Pomona, California.


 

Assessment in the study was done by a clinical psychologist, but I would think anyone could be trained to do this.

 

Measures:

(1) pain behavior (wincing, moaning, overly cautious movement, pain complaint)

(2) assertiveness

(3) comprehension of model of program

(4) comprehension of pain/anxiety relationship

Measure

Finding

Points

pain behavior (verbal and/or nonverbal)

severe (marked and frequent)

1

 

moderate

2

 

mild

3

 

negligible

4

assertiveness

low (almost never, to the point of passivity; marked holding in and/or delaying, especially regarding negative interpersonal reactions)

1

 

sometimes assertive

2

 

frequently assertive

3

 

highly assertive

4

comprehension of model of program (favors self-initiation and self-reliance)

poor understanding (no application of self-initiation and self-reliance)

1

 

fair to good understanding

2

 

good understanding

3

 

excellent understanding

4

comprehension of pain/anxiety relationship

poor understanding, no ability to apply

1

 

fair to good understanding, initial application attempts

2

 

good understanding, some application

3

 

excellent understanding, frequent and early applications

4

 

where:

• I prefer to use aggressiveness rather than assertiveness.

• These items are a subset of the Functional Improvement Measure by the authors for low back pain (see above).

 

total score =

= SUM(all 4 parameters)

 

Interpretation:

• minimal score: 4

• maximal score: 16

• The higher the score, the better the patient's performance.

 


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Specialty

Objective

ICD-10